Provider Demographics
NPI:1013106939
Name:EVERNORTH DIRECT HEALTH LLC
Entity Type:Organization
Organization Name:EVERNORTH DIRECT HEALTH LLC
Other - Org Name:COH, LLC DBA CIGNA RX, A WHOLLY OWNED SUBSIDIARY OF CGLIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY AREA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARJU
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:623-277-1168
Mailing Address - Street 1:801 BOARDWALK
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-7509
Mailing Address - Country:US
Mailing Address - Phone:609-343-4188
Mailing Address - Fax:609-343-4214
Practice Address - Street 1:801 BOARDWALK
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7509
Practice Address - Country:US
Practice Address - Phone:609-343-4188
Practice Address - Fax:609-343-4214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS00674900302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJRS00674900OtherNJ BOARD OF PHARMACY PERM