=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245492339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAREMARK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2008
-----------------------------------------------------
Last Update Date | 02/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 970 N KALAHEO AVE PALI PALMS PLAZA C 106
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-1866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-254-6622
-----------------------------------------------------
Fax | 808-254-6153
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9501 E SHEA BLVD MC024
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-6719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC
-----------------------------------------------------
Name | RICHARD CHOW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-254-6622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY663
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------