1811206071 NPI number — ACARIAHEALTH PHARMACY 12 INC

Table of content: (NPI 1811206071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811206071 NPI number — ACARIAHEALTH PHARMACY 12 INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACARIAHEALTH PHARMACY 12 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:
ACARIAHEALTH PHARMACY #12
Provider Other Organization Name Type Code:
3
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:
1811206071
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:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 SKYLINE DR STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAWTHORNE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10532-2166
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:
10/05/2010

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: 3336S0011X , with the licence number: PH02751 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 8788455-1708 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PHN10492 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: NP000271 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 036.0086823 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 14829 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 27747 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 022156100 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: MO40001550 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: MO0560285 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: NR0859 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PCN.0002265 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 28RO00060600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 030446 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1811206071 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811206071 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811206071 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103040076 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2133866 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3262360 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7N0446 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0287865 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1021594 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0054586 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3094449 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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