Provider Demographics
NPI:1588657688
Name:CAREMARK SRX INC
Entity Type:Organization
Organization Name:CAREMARK SRX INC
Other - Org Name:J & N PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HEMAGIRI
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:GAYAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-293-2233
Mailing Address - Street 1:1220 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3117
Mailing Address - Country:US
Mailing Address - Phone:718-293-2233
Mailing Address - Fax:718-681-0505
Practice Address - Street 1:1220 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3117
Practice Address - Country:US
Practice Address - Phone:718-293-2233
Practice Address - Fax:718-681-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026098333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3320354OtherNCPDP NUMBER
NY02387699Medicaid
NY02387699Medicaid
NYBC8497946OtherDEA NUMBER