Healthcare Provider Details

I. General information

NPI: 1003418948
Provider Name (Legal Business Name): CAREMAX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2789 PARK ST STE B
JACKSONVILLE FL
32205-7607
US

IV. Provider business mailing address

PO BOX 600489
JACKSONVILLE FL
32260-0489
US

V. Phone/Fax

Practice location:
  • Phone: 904-551-9026
  • Fax: 904-758-3519
Mailing address:
  • Phone: 904-551-9026
  • Fax: 904-758-3519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VIPUL MAMTORA
Title or Position: MBR/MGR
Credential:
Phone: 904-551-9026