Organization
CORAM ALTERNATE SITE SERVICES INC
Active
Parent organization
CORAM ALTERNATE SITE SERVICES INC
Other names
Coram CVS/specialty Infusion Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
CORAM ALTERNATE SITE SERVICES INC
Authorized official
TRICIA LACAVICH (PRESIDENT)
(314) 306-3255
Entity
Organization
Contact information
Practice address
12310 WORLD TRADE DR, SUITE 100, SAN DIEGO, CA 92128-3793
(858) 576-6969
(858) 974-6606
Mailing address
PO BOX 809160, CHICAGO, IL 60680-9160
(480) 765-5043
(401) 733-0211
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
0800429
CA
251F00000X
Home Infusion Agency
0800429
CA
261QI0500X
Infusion Therapy Clinic/Center
—
CA
332B00000X
Durable Medical Equipment & Medical Supplies
PHY50273
CA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
PHY50273
CA
333600000X
Pharmacy
PHY50273
CA
3336C0003X
Community/Retail Pharmacy
PHY50273
CA
3336C0004X
Compounding Pharmacy
PHY50273
CA
3336H0001X
Home Infusion Therapy Pharmacy
Primary
PHY50273
CA
3336M0002X
Mail Order Pharmacy
PHY50273
CA
3336S0011X
Specialty Pharmacy
PHY50273
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0522311
NCPDP
—
01
—
0800429
HOME HEALTH AGENCY
CA
01
—
101225
MEDICAL DEVICE RETAILER
CA
05
—
PHA409320
—
CA
01
—
PHY50273
PHARMACY LICES
CA
Enumeration date
05/05/2006
Last updated
03/07/2023
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