1972057248 NPI number — PHARMACY CORPORATION OF AMERICA

Table of content: (NPI 1972057248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972057248 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:
1972057248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 409244
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-9244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-378-6274
Provider Business Mailing Address Fax Number:
813-318-6346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6330 E 75TH ST
Provider Second Line Business Practice Location Address:
STE 322
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46250-2777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-678-7575
Provider Business Practice Location Address Fax Number:
317-595-6283
Provider Enumeration Date:
08/04/2016

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 PRESIDENT
Authorized Official Telephone Number:
502-627-7100

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X , with the licence number:  60005275A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com