Provider Demographics
NPI:1386783629
Name:PRIME CARE INC
Entity type:Organization
Organization Name:PRIME CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HUDDLESTON
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELIMO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:671-649-9400
Mailing Address - Street 1:PO BOX 11864
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-649-9400
Mailing Address - Fax:671-649-1455
Practice Address - Street 1:851 GOVERNOR CARLOS CAMACHO RD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-649-9400
Practice Address - Fax:671-649-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPCY048333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU5400015OtherNCPOP