1932110509 NPI number — PHARMACY CORPORATION OF AMERICA

Table of content: (NPI 1932110509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932110509 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:
1932110509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2014
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:
800-825-6408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7101 US HIGHWAY 90
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
DAPHNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36526-9512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-770-7923
Provider Business Practice Location Address Fax Number:
866-478-7909
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANERIS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VICE PREISDENT
Authorized Official Telephone Number:
502-627-7100

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 112833 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1995938 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 021966500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100003728 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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