1225603830 NPI number — CAREMAX PHARMACY OF LOUDON, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225603830 NPI number — CAREMAX PHARMACY OF LOUDON, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREMAX PHARMACY OF LOUDON, 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:
1225603830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3033 W PRESIDENT GEORGE BUSH HWY # 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75075-5752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-542-0550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 GRASSMERE PARK STE 19A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37211-3681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
629-240-7070
Provider Business Practice Location Address Fax Number:
629-895-0115
Provider Enumeration Date:
05/25/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LARSEN
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
DELEGATED OFFICIAL
Authorized Official Telephone Number:
214-542-0550

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: 332BP3500X ; 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: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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