Provider Demographics
NPI:1699096842
Name:ACARIAHEALTH PHARMACY #14, INC.
Entity type:Organization
Organization Name:ACARIAHEALTH PHARMACY #14, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CICCOLELLA-KAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-422-2742
Mailing Address - Street 1:PO BOX 956780
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-6780
Mailing Address - Country:US
Mailing Address - Phone:855-422-2742
Mailing Address - Fax:
Practice Address - Street 1:4151 E COMMERCE WAY # 1041
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-9679
Practice Address - Country:US
Practice Address - Phone:916-927-0336
Practice Address - Fax:877-541-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 332B00000X, 332BP3500X
CAPHY51424333600000X
COOSP.000658723336C0003X
HIPMP-8613336S0011X
AK11743336S0011X
NVPH026663336S0011X
WAPHNR.FO.602428703336S0011X
ID21938MS3336S0011X
NY0304263336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1699096842Medicaid
ID1699096842Medicaid
AK1578903Medicaid
CA1699096842Medicaid
NV1699096842Medicaid
2133837OtherPK
AK1578903Medicaid