Provider Demographics
NPI:1053585257
Name:CAREMARK PUERTO RICO SPECIALTY
Entity type:Organization
Organization Name:CAREMARK PUERTO RICO SPECIALTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-3303
Mailing Address - Street 1:PO BOX 99794
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60696-7594
Mailing Address - Country:US
Mailing Address - Phone:412-824-2487
Mailing Address - Fax:412-717-9352
Practice Address - Street 1:6020 AVE ROBERTO SANCHEZ VILELLA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-3707
Practice Address - Country:US
Practice Address - Phone:787-759-4160
Practice Address - Fax:909-799-4364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
6123130001Medicare NSC