Provider Demographics
NPI:1326064213
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:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANERIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-627-7100
Mailing Address - Street 1:1100 WILSON WAY SE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-7248
Mailing Address - Country:US
Mailing Address - Phone:800-678-7221
Mailing Address - Fax:800-722-3599
Practice Address - Street 1:11205 KNOTT AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5489
Practice Address - Country:US
Practice Address - Phone:714-890-8469
Practice Address - Fax:800-478-4526
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-14
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ302597Medicaid
WA9059197Medicaid
IL=========0Medicaid
IL=========0Medicaid
0196160074Medicare NSC