1902106453 NPI number — CHEM RX PHARMACY SERVICES, LLC

Table of content: MRS. RACHEL LAWRENCE GAROFALO PA (NPI 1497184220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902106453 NPI number — CHEM RX PHARMACY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEM RX PHARMACY SERVICES, LLC
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:
PHARMERICA
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:
1902106453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 409244
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-9244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-378-6274
Provider Business Mailing Address Fax Number:
813-318-6346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 CHARLES LINDBERGH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11553-3658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-536-0800
Provider Business Practice Location Address Fax Number:
516-889-4500
Provider Enumeration Date:
11/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
502-630-7429

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 030467 , 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: 1902106453 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0718432 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5801976 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03320394 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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