Healthcare Provider Details

I. General information

NPI: 1811206071
Provider Name (Legal Business Name): ACARIAHEALTH PHARMACY 12 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 02/25/2024
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SKYLINE DR STE 240
HAWTHORNE NY
10532-2166
US

IV. Provider business mailing address

PO BOX 956780
SAINT LOUIS MO
63195-6780
US

V. Phone/Fax

Practice location:
  • Phone: 800-511-5144
  • Fax: 866-834-8523
Mailing address:
  • Phone: 855-422-2742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPH02751
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number8788455-1708
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHN10492
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number28RO00060600
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberNP000271
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number036.0086823
License Number StateVT
# 8
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number022156100
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberMO40001550
License Number StateME
# 10
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberMO0560285
License Number StateWV
# 11
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberNR0859
License Number StateNH
# 12
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPCN.0002265
License Number StateCT
# 13
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number14829
License Number StateSC
# 14
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number27747
License Number StateTX
# 15
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number030446
License Number StateNY

VIII. Authorized Official

Name: JESSICA CICCOLELLA-KAHL
Title or Position: PRESIDENT
Credential:
Phone: 855-422-2742