Healthcare Provider Details

I. General information

NPI: 1588657688
Provider Name (Legal Business Name): CAREMARK SRX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MORRIS AVE
BRONX NY
10456-3117
US

IV. Provider business mailing address

1220 MORRIS AVE
BRONX NY
10456-3117
US

V. Phone/Fax

Practice location:
  • Phone: 718-293-2233
  • Fax: 718-681-0505
Mailing address:
  • Phone: 718-293-2233
  • Fax: 718-681-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number026098
License Number StateNY

VIII. Authorized Official

Name: MR. HEMAGIRI REDDY GAYAM
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 718-293-2233