Provider Demographics
NPI:1033512884
Name:CAREMAX COMMUNITY PHARMACY LLC
Entity Type:Organization
Organization Name:CAREMAX COMMUNITY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-692-1603
Mailing Address - Street 1:418 S GAY ST
Mailing Address - Street 2:STE 104
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37902-1134
Mailing Address - Country:US
Mailing Address - Phone:865-692-1603
Mailing Address - Fax:865-692-1604
Practice Address - Street 1:418 S GAY ST
Practice Address - Street 2:STE 104
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37902-1134
Practice Address - Country:US
Practice Address - Phone:865-692-1605
Practice Address - Fax:865-692-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X
TN00000054663336L0003X
TN54663336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159819OtherPK