Provider Demographics
NPI:1164443214
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: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
Mailing Address - Street 2:STE 150
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-1125
Mailing Address - Country:US
Mailing Address - Phone:813-318-6039
Mailing Address - Fax:800-825-6408
Practice Address - Street 1:376 W LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2915
Practice Address - Country:US
Practice Address - Phone:801-486-9555
Practice Address - Fax:801-486-4939
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-22
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
UT7029950-17043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808144200Medicaid
WYNR50217OtherSTATE BOARD OF PHARMACY
WY1164443214Medicaid
WY127255100Medicaid
WY126793100Medicaid
NVPH02386OtherSTATE BOARD OF PHARMACY
NV1164443214Medicaid
UT7029950-1704OtherSTATE BOARD OF PHARMACY
ID808134000Medicaid
UT1164443214Medicaid
ID14196MSOtherSTATE BOARD OF PHARMACY
WY126793100Medicaid