Healthcare Provider Details

I. General information

NPI: 1386783629
Provider Name (Legal Business Name): PRIME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 GOVERNOR CARLOS CAMACHO RD
TAMUNING GU
96913
US

IV. Provider business mailing address

PO BOX 11864
TAMUNING GU
96913
US

V. Phone/Fax

Practice location:
  • Phone: 671-649-9400
  • Fax: 671-649-1455
Mailing address:
  • Phone: 671-649-9400
  • Fax: 671-649-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPCY048
License Number StateGU

VIII. Authorized Official

Name: MS. MARY CHARGUALAF
Title or Position: BUSINESS ADMIN
Credential:
Phone: 671-632-6001