Provider Demographics
NPI:1265725808
Name:CARE PHARMACCYLLC
Entity type:Organization
Organization Name:CARE PHARMACCYLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-997-3740
Mailing Address - Street 1:777 CRAIG RD
Mailing Address - Street 2:SUITE 135A
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7138
Mailing Address - Country:US
Mailing Address - Phone:314-997-3740
Mailing Address - Fax:314-997-3742
Practice Address - Street 1:777 CRAIG RD
Practice Address - Street 2:SUITE 135A
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7138
Practice Address - Country:US
Practice Address - Phone:314-997-3740
Practice Address - Fax:314-997-3742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X, 3336L0003X, 3336M0002X
MO20110122583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2639699OtherNCPDP PROVIDER IDENTIFICATION NUMBER