1922031590 NPI number — PHARMACY CORPORATION OF AMERICA

Table of content: (NPI 1922031590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922031590 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:
1922031590
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
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:
1100 WILSON WAY SE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30082-7210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-432-1621
Provider Business Practice Location Address Fax Number:
800-722-3599
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: PHRE006806 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 501299 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00255516A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1136298 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1136298 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1922031590 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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