Organization
TAKECARE INS CO INC
Active
Other names
FHP PHARMACY GUAM
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY LARSEN PHARMD (PRESIDENT)
(671) 646-6956
Entity
Organization
Contact information
Practice address
548 S MARINE CORPS DR, TAMUNING, GU 96913-3539
(671) 646-5825
(671) 646-0786
Mailing address
PO BOX 6578, TAMUNING, GU 96931-6578
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY005
GU
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2112138
PK
—
Enumeration date
08/10/2006
Last updated
04/06/2017
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