Provider Demographics
NPI:1073733408
Name:ACARIAHEALTH PHARMACY #26, INC.
Entity Type:Organization
Organization Name:ACARIAHEALTH PHARMACY #26, INC.
Other - Org Name:WELLCARE SPECIALTY PHARMACY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:CICCOLELLA-KAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-422-2742
Mailing Address - Street 1:8715 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1143
Mailing Address - Country:US
Mailing Address - Phone:866-458-9246
Mailing Address - Fax:886-458-9245
Practice Address - Street 1:8715 HENDERSON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1143
Practice Address - Country:US
Practice Address - Phone:866-458-9246
Practice Address - Fax:866-458-9245
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACARIAHEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-26
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X
FLPH226693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1073733408Medicaid
FLPH22669OtherPHARMACY LICENSE
NC1073733408Medicaid
OH1073733408Medicaid
UT3014228Medicaid
NH3128603Medicaid
NJ0387550Medicaid
NY05743811Medicaid
NE10026581500Medicaid
HI1073733408Medicaid
AZ1073733408Medicaid
NM1073733408Medicaid
SC7F2669Medicaid
AZ241842Medicaid
KY7100220090Medicaid
PA103767416Medicaid
MI1073733408Medicaid
IN300038102Medicaid
FL032112500Medicaid
WA2157757Medicaid
CA1073733408Medicaid
OR500778781Medicaid
TX582077Medicaid