Healthcare Provider Details

I. General information

NPI: 1912541228
Provider Name (Legal Business Name): ACARIAHEALTH PHARMACY 13 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 GARFIELD AVE
COMMERCE CA
90040-3102
US

IV. Provider business mailing address

PO BOX 956780
SAINT LOUIS MO
63195-6780
US

V. Phone/Fax

Practice location:
  • Phone: 800-511-5144
  • Fax: 877-541-1503
Mailing address:
  • Phone: 855-422-2742
  • Fax: 877-801-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JESSICA DAWN CICCOLELLA-KAHL
Title or Position: PRESIDENT
Credential:
Phone: 800-511-5144