1912055948 NPI number — CAREMARK CARECENTER PHARMACY, L.L.C.

Table of content: (NPI 1912055948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912055948 NPI number — CAREMARK CARECENTER PHARMACY, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREMARK CARECENTER PHARMACY, L.L.C.
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:
CAREMARK IOWA CARECENTER PHARMACY I, LLC
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:
1912055948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPARTMENT 6175
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90088-6175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-225-5967
Provider Business Mailing Address Fax Number:
909-799-4364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 86TH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
URBANDALE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50322-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-276-0073
Provider Business Practice Location Address Fax Number:
515-276-9433
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ERNST
Authorized Official First Name:
CORY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
800-225-5967

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1303 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 1303 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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