1760464523 NPI number — CAREMARK LLC

Table of content: (NPI 1760464523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760464523 NPI number — CAREMARK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREMARK 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:
CAREMARK ILLINOIS MAIL PHARMACY LLC DBA CVS CAREMARK
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:
1760464523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 840688
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-0688
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:
800 BIERMANN CT
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
MT PROSPECT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60056-2151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-634-7900
Provider Business Practice Location Address Fax Number:
847-634-7832
Provider Enumeration Date:
11/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARKOS
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, TREASURER
Authorized Official Telephone Number:
800-225-5967

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  054015388 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 054015388 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1473898 . This is a "NEW YORK STATE ASSISTANCE PROGRAM (EPIC NEW YORK SENIOR PRESCRIPTION PLAN)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1760464523 . This is a "PENNSYLVANIA STATE PROGRAMS: PACE, SPBP & CRDP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0191060 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203171 . This is a "MEDICARE B" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0191060 . This is a "NEW JERSEY STATE PROGRAMS: PAAD, SENIOR GOLD, ADDP & CYSTIC FIBROSIS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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