Provider Demographics
NPI:1285667865
Name:PHARMACY CORPORATION OF AMERICA
Entity Type:Organization
Organization Name:PHARMACY CORPORATION OF AMERICA
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:813-318-6039
Mailing Address - Fax:
Practice Address - Street 1:5255 E RIVER RD
Practice Address - Street 2:SUITE 204
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55421-1026
Practice Address - Country:US
Practice Address - Phone:763-571-2220
Practice Address - Fax:763-571-3311
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
MN26154803336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2406785Medicaid
MN661057900Medicaid
SD9151500Medicaid
2406785OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IA939108Medicaid
IA2406785Medicaid
WI1285667865Medicaid
SC7M1548Medicaid
WI33037000Medicaid
SD8532032Medicaid
IN200526100AMedicaid
SD9151500Medicaid
2406785OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IA939108Medicaid
MN661057900Medicaid
IA939108Medicaid