1558394130 NPI number — PHARMACY CORPORATION OF AMERICA

Table of content: (NPI 1558394130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558394130 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:
1558394130
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:
350 MYLES STANDISH BLVD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAUNTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02780-7387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-427-5000
Provider Business Practice Location Address Fax Number:
508-587-3645
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: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 2796 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X , with the licence number: 3599 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 010319153 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2235112 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03179917 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1002841 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558394130 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558394130 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30009810 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0423131 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1004936 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004128600 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0192091 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110022080A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DR00409 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558394130 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558394130 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 187440000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 194400001 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02206417 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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