Provider Demographics
NPI:1114950789
Name:PHARMERICA DRUG SYSTEMS LLC
Entity Type:Organization
Organization Name:PHARMERICA DRUG SYSTEMS LLC
Other - Org Name:PHARMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
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:502-394-2100
Mailing Address - Fax:502-627-7401
Practice Address - Street 1:11205 KNOTT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5489
Practice Address - Country:US
Practice Address - Phone:714-891-5145
Practice Address - Fax:714-901-2468
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CAPHY487093336L0003X
CALSC990793336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA114950789Medicaid
0595287OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA460540Medicaid
CA114950789Medicaid