1366475949 NPI number — PHARMERICA DRUG SYSTEMS LLC

Table of content: (NPI 1366475949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366475949 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:
1366475949
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:
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:
749 A SIMPSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIMPSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-669-6690
Provider Business Practice Location Address Fax Number:
252-329-9729
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: 09839 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0745829 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3430446 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7N7931 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".