Healthcare Provider Details

I. General information

NPI: 1629341177
Provider Name (Legal Business Name): CAREMARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 WALL STREET
MT. PROSPEC IL
60056
US

IV. Provider business mailing address

1780 WALL ST
MT PROSPECT IL
60056-5790
US

V. Phone/Fax

Practice location:
  • Phone: 847-634-7959
  • Fax: 909-799-4364
Mailing address:
  • Phone: 847-634-7959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRANDON AYCOCK
Title or Position: PRESIDENT
Credential:
Phone: 401-770-3303