1801802210 NPI number — PHARMACY CORPORATION OF AMERICA

Table of content: (NPI 1801802210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801802210 NPI number — PHARMACY CORPORATION OF AMERICA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACY CORPORATION OF AMERICA
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:
PHAR MERICA
Provider Other Organization Name Type Code:
5
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:
1801802210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2013
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
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33619-1125
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:
1100 WILSON WAY
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-432-1621
Provider Business Practice Location Address Fax Number:
800-722-3599
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANERIS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
502-627-7100

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1558559 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200264800A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000255516B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100080240D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9151500 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009610640 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106298101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55365 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 622449114 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009149368 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33037000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7701221 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0392427 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150921801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1801802210 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3541753 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000795600 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: PC72436 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 033685800 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30009810 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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