Provider Demographics
NPI:1700233160
Name:CAREMARK CALIFORNIA SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:CAREMARK CALIFORNIA SPECIALTY PHARMACY, LLC
Other - Org Name:CVS SPECIALTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-799-4174
Mailing Address - Street 1:1110 RESEARCH DR STE B
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4562
Mailing Address - Country:US
Mailing Address - Phone:909-796-7171
Mailing Address - Fax:909-799-6462
Practice Address - Street 1:1110 RESEARCH DR STE B
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4562
Practice Address - Country:US
Practice Address - Phone:909-796-7171
Practice Address - Fax:909-799-6462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAREMARK, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY53625333600000X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy