1629195045 NPI number — ACARIAHEALTH PHARMACY 11 INC

Table of content: (NPI 1629195045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629195045 NPI number — ACARIAHEALTH PHARMACY 11 INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACARIAHEALTH PHARMACY 11 INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629195045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 956780
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63195-6780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-422-2742
Provider Business Mailing Address Fax Number:
866-834-8523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1311 W SAM HOUSTON PKWY N STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-511-5144
Provider Business Practice Location Address Fax Number:
866-834-8523
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CICCOLELLA-KAHL
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
855-422-2742

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100264790-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 709240 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003136163A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0161049 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200602430A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200921260A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 194389407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2133868 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7T5485 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86135562 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000143094 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200241760A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6031595 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146690 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1028435 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629195045 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629195045 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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