1699069302 NPI number — PHARMACY CORPORATION OF AMERICA

Table of content: (NPI 1699069302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699069302 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:
1699069302
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:
502-627-7100
Provider Business Mailing Address Fax Number:
855-217-7498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1667 E LANDIS AVE BLDG 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08361-2942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-732-2940
Provider Business Practice Location Address Fax Number:
855-572-6856
Provider Enumeration Date:
05/31/2011

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: 3336C0003X , with the licence number:  28RS00712300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 28RS00712300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A9-0012675 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: D111122200 . This is a "CONTROLLED SUBSTANCE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 28RS00758400 . This is a "PHARMACY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NP001145 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0196160091 . This is a "NATIONAL SUPPLIER CLEARINGHOUSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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