Provider Demographics
NPI:1336150838
Name:TAKECARE INSURANCE COMPANY, INC.
Entity Type:Organization
Organization Name:TAKECARE INSURANCE COMPANY, INC.
Other - Org Name:FHP PHARMACY, SAIPAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, HEALTH PLAN ADMINISTRATO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-646-6956
Mailing Address - Street 1:P.O. BOX 500118
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-234-6584
Mailing Address - Fax:670-234-3742
Practice Address - Street 1:2ND FLOOR TSL PLAZA
Practice Address - Street 2:GARAPAN
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-234-6584
Practice Address - Fax:670-234-3742
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAKECARE INSURANCE COMPANY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-10
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MPRP-0023336C0002X, 3336C0003X
3336M0003X
MPRP-0013336C0003X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MP5500043OtherNCPDP NUMBER