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General NPI Number Information
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NPI Number | 1629195045
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Entity Type | Organization
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Legal Business Name | ACARIAHEALTH PHARMACY 11 INC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 02/25/2024
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Provider Practice Location Address
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Address Line | 1311 W SAM HOUSTON PKWY N STE 130
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City | HOUSTON
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State | TX
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Zip | 77043
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Country | US
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Telephone | 800-511-5144
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Fax | 866-834-8523
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Provider Business Mailing Address
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Address Line | PO BOX 956780
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City | SAINT LOUIS
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State | MO
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Zip | 63195-6780
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Country | US
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Telephone | 855-422-2742
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Fax | 866-834-8523
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA CICCOLELLA-KAHL
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Credential |
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Telephone | 855-422-2742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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