Active NPI
Acariahealth Pharmacy 12 Inc
Doing business as AcariaHealth Pharmacy #12
- Specialty Pharmacy
- Hawthorne, NY
National Provider Identifier
1811206071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialty Pharmacy
- License
- 030446
- Legal business name
- ACARIAHEALTH PHARMACY 12 INC
- Doing business as
- AcariaHealth Pharmacy #12
- Practice address
- 5 Skyline Dr Ste 240
Hawthorne, NY 10532-2166 - Phone
- (800) 511-5144
- Fax
- (866) 834-8523
- NPI assigned
- Oct 5, 2010
- Last updated
- Feb 25, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jessica Ciccolella-Kahl
- Title
- President
- Phone
- (855) 422-2742
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Infusion Agency | 251F00000X | NU | ||
| Specialty Pharmacy | 3336S0011X | PH02751 | NV | |
| Specialty Pharmacy | 3336S0011X | 8788455-1708 | UT | |
| Specialty Pharmacy | 3336S0011X | PHN10492 | RI | |
| Specialty Pharmacy | 3336S0011X | NP000271 | PA | |
| Specialty Pharmacy | 3336S0011X | 036.0086823 | VT | |
| Specialty Pharmacy | 3336S0011X | 14829 | SC | |
| Specialty Pharmacy | 3336S0011X | 27747 | TX | |
| Specialty Pharmacy | 3336S0011X | 022156100 | OH | |
| Specialty Pharmacy | 3336S0011X | MO40001550 | ME | |
| Specialty Pharmacy | 3336S0011X | MO0560285 | WV | |
| Specialty Pharmacy | 3336S0011X | NR0859 | NH | |
| Specialty Pharmacy | 3336S0011X | PCN.0002265 | CT | |
| Specialty Pharmacy | 3336S0011X | 28RO00060600 | NJ | |
| Specialty Pharmacy | 3336S0011X | 030446 | NY | Primary |
Addresses
Primary practice location
5 Skyline Dr Ste 240
Hawthorne, NY 10532-2166
Mailing address
PO Box 956780
Saint Louis, MO 63195-6780
Phone (855) 422-2742
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0287865 | Medicaid | NJ | |
| 1811206071 | Medicaid | CT | |
| 7N0446 | Medicaid | SC | |
| 103040076 0001 | Medicaid | PA | |
| 1811206071 | Medicaid | UT | |
| 2133866 | Other | PK | |
| 3094449 | Medicaid | NH | |
| 1021594 | Medicaid | VT | |
| 3262360 | Medicaid | NY | |
| 0054586 | Medicaid | OH | |
| 1811206071 | Medicaid | TN |
Other names 1
- AcariaHealth Pharmacy #12
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110322000978 | NY | DME Supplier - Pharmacy | 3971786369 | Practice locations: Hawthorne, NY |
| O20160615001342 | NY | Part B Supplier - Pharmacy | 3971786369 | Practice locations: Hawthorne, NY |
National Provider Directory
National Provider DirectoryLocations
5 Skyline Dr
Ste 240
Hawthorne, NY 10532
Phone (914) 789-5091
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286236800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1708819200000",
"number": "1811206071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 956780",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631956780",
"telephone_number": "855-422-2742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 SKYLINE DR STE 240",
"city": "HAWTHORNE",
"state": "NY",
"postal_code": "105322166",
"telephone_number": "800-511-5144",
"fax_number": "866-834-8523"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ACARIAHEALTH PHARMACY 12 INC",
"organizational_subpart": "NO",
"enumeration_date": "2010-10-05",
"last_updated": "2024-02-25",
"certification_date": "2023-07-31",
"status": "A",
"authorized_official_last_name": "CICCOLELLA-KAHL",
"authorized_official_first_name": "JESSICA",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "855-422-2742"
},
"taxonomies": [
{
"code": "251F00000X",
"taxonomy_group": "",
"desc": "Home Infusion",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "NV",
"license": "PH02751",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "UT",
"license": "8788455-1708",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "RI",
"license": "PHN10492",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "PA",
"license": "NP000271",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "VT",
"license": "036.0086823",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "SC",
"license": "14829",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "TX",
"license": "27747",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "OH",
"license": "022156100",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "ME",
"license": "MO40001550",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "WV",
"license": "MO0560285",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "NH",
"license": "NR0859",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "CT",
"license": "PCN.0002265",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "NJ",
"license": "28RO00060600",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "NY",
"license": "030446",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0287865",
"state": "NJ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1811206071",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7N0446",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103040076 0001",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1811206071",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2133866",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3094449",
"state": "NH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1021594",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3262360",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0054586",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1811206071",
"state": "TN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "AcariaHealth Pharmacy #12",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "AcariaHealth Pharmacy #12",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Hawthorne, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.