Healthcare Provider Details

I. General information

NPI: 1417596511
Provider Name (Legal Business Name): CAREMARK L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7251 S EASTERN AVE
LAS VEGAS NV
89119-4507
US

IV. Provider business mailing address

1127 BRYN MAWR AVE STE A
REDLANDS CA
92374-4558
US

V. Phone/Fax

Practice location:
  • Phone: 866-833-3752
  • Fax:
Mailing address:
  • Phone: 909-799-4174
  • Fax: 909-799-4364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRANDON AYCOCK
Title or Position: PRESIDENT
Credential:
Phone: 800-746-7287