1013028042 NPI number — PHARMERICA EAST LLC

Table of content: (NPI 1013028042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013028042 NPI number — PHARMERICA EAST LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMERICA EAST LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013028042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3802 CORPOREX PARK DR STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33619-1135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-318-6039
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 LAKEVIEW PLAZA BLVD
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
WORTHINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-430-9720
Provider Business Practice Location Address Fax Number:
614-430-9732
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
502-630-7429

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  02788 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200943370A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: PSNH021508850 . This is a "OH BOARD OF PHARMACY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: PSNH.021508850 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 101402588-0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2531433 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: MO0560122 . This is a "WV BOARD OF PHARMACY" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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