1477651354 NPI number — PHARMACY CORPORATION OF AMERICA

Table of content: (NPI 1477651354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477651354 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:
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:
1477651354
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:
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:
855-217-7498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8431 GARVEY DR
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27616-3267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-534-1385
Provider Business Practice Location Address Fax Number:
919-534-1386
Provider Enumeration Date:
09/21/2006

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: 333600000X , with the licence number:  0214001813 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 11744 , 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: 1477651354 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7N3115 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14002 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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