Provider Demographics
NPI:1912055948
Name:CAREMARK CARECENTER PHARMACY, L.L.C.
Entity Type:Organization
Organization Name:CAREMARK CARECENTER PHARMACY, L.L.C.
Other - Org Name:CAREMARK IOWA CARECENTER PHARMACY I, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ERNST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:800-225-5967
Mailing Address - Street 1:DEPARTMENT 6175
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90088-6175
Mailing Address - Country:US
Mailing Address - Phone:800-225-5967
Mailing Address - Fax:909-799-4364
Practice Address - Street 1:2901 86TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4201
Practice Address - Country:US
Practice Address - Phone:515-276-0073
Practice Address - Fax:515-276-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1303332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies