1073733408 NPI number — ACARIAHEALTH PHARMACY #26, INC.

Table of content: (NPI 1073733408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073733408 NPI number — ACARIAHEALTH PHARMACY #26, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACARIAHEALTH PHARMACY #26, 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:
WELLCARE SPECIALTY PHARMACY, INC.
Provider Other Organization Name Type Code:
4
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:
1073733408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8715 HENDERSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33634-1143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-458-9246
Provider Business Mailing Address Fax Number:
886-458-9245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8715 HENDERSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33634-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-458-9246
Provider Business Practice Location Address Fax Number:
866-458-9245
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CICCOLELLA-KAHL
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
DAWN
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: 3336C0003X , with the licence number: PH22669 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1073733408 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PH22669 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1073733408 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073733408 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3014228 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3128603 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0387550 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05743811 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026581500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073733408 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073733408 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073733408 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7F2669 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 241842 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100220090 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103767416 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073733408 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300038102 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 032112500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2157757 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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