Healthcare Provider Details

I. General information

NPI: 1265805253
Provider Name (Legal Business Name): CAREMORE HEALTH PLAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 MCHENRY AVE
MODESTO CA
95350-5373
US

IV. Provider business mailing address

1234 MCHENRY AVE
MODESTO CA
95350-5373
US

V. Phone/Fax

Practice location:
  • Phone: 209-544-2554
  • Fax:
Mailing address:
  • Phone: 209-544-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberA76149
License Number StateCA

VIII. Authorized Official

Name: JAMES ROSE
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 562-862-3684