Provider Demographics
NPI:1700204187
Name:CVS CAREMARK SPECIALTY PHARMACY
Entity Type:Organization
Organization Name:CVS CAREMARK SPECIALTY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:800-447-4791
Mailing Address - Street 1:180 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-3516
Mailing Address - Country:US
Mailing Address - Phone:800-447-4791
Mailing Address - Fax:
Practice Address - Street 1:180 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-3516
Practice Address - Country:US
Practice Address - Phone:800-447-4791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03474000302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization