Provider Demographics
NPI:1013028042
Name:PHARMERICA EAST LLC
Entity Type:Organization
Organization Name:PHARMERICA EAST LLC
Other - Org Name:PHARMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-630-7429
Mailing Address - Street 1:3802 CORPOREX PARK DR STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-1135
Mailing Address - Country:US
Mailing Address - Phone:813-318-6039
Mailing Address - Fax:
Practice Address - Street 1:720 LAKEVIEW PLAZA BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085
Practice Address - Country:US
Practice Address - Phone:614-430-9720
Practice Address - Fax:614-430-9732
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH027883336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200943370AMedicaid
OHPSNH021508850OtherOH BOARD OF PHARMACY
OHPSNH.021508850OtherBOARD OF PHARMACY
PA101402588-0002Medicaid
OH2531433Medicaid
WVMO0560122OtherWV BOARD OF PHARMACY
WVMO0560122OtherWV BOARD OF PHARMACY
OHPSNH.021508850OtherBOARD OF PHARMACY
KY71001201100Medicaid
PA101402588-0002Medicaid