1285667865 NPI number — PHARMACY CORPORATION OF AMERICA

Table of content: (NPI 1285667865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285667865 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:
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:
1285667865
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:
5255 E RIVER RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
FRIDLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55421-1026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-571-2220
Provider Business Practice Location Address Fax Number:
763-571-3311
Provider Enumeration Date:
07/08/2006

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: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 2615480 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2406785 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 661057900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9151500 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2406785 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 939108 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2406785 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285667865 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7M1548 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33037000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8532032 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200526100A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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