1396778965 NPI number — PHARMERICA DRUG SYSTEMS LLC

Table of content: (NPI 1396778965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396778965 NPI number — PHARMERICA DRUG SYSTEMS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMERICA DRUG SYSTEMS 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:
PHARMERICA
Provider Other Organization Name Type Code:
3
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:
1396778965
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 N WHITTINGTON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40222-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-627-7000
Provider Business Mailing Address Fax Number:
502-627-7401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
873 RICARDO CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401-7174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-543-5981
Provider Business Practice Location Address Fax Number:
805-546-1979
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
502-394-2100

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PHY48712 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHA460590 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PHY48712 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: LSC99597 . This is a "STERILE COMPOUNDING LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0589513 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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