PHARMACY CORPORATION OF AMERICA

Provider Demographics

• NPI: 1558394130
• 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 - First Name: ALLISON
• Authorized Official - Middle Name: L
• Authorized Official - Last Name: BROWN
• Authorized Official - Phone: 502-630-7429
• Mailing Address - Street 1: 3802 CORPOREX PARK DR STE 150
• Mailing Address - City: TAMPA
• Mailing Address - State: FL
• Mailing Address - Zip Code: 33619-1135
• Mailing Address - Country: US
• Mailing Address - Phone: 813-318-6039
• Practice Address - Street 1: 350 MYLES STANDISH BLVD STE 104
• Practice Address - City: TAUNTON
• Practice Address - State: MA
• Practice Address - Zip Code: 02780-7387
• Practice Address - Country: US
• Practice Address - Phone: 508-427-5000
• Practice Address - Fax: 508-587-3645
• 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

Provider Licenses

State	License ID	Taxonomies
		332B00000X, 332BP3500X, 3336C0003X, 3336L0003X
MA	2796	333600000X
MA	3599	3336L0003X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336L0003X	Suppliers	Pharmacy	Long Term Care Pharmacy
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	332BP3500X	Suppliers	Durable Medical Equipment & Medical Supplies	Parenteral & Enteral Nutrition
No	333600000X	Suppliers	Pharmacy
No	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
VA	010319153	Medicaid
	2235112	Other	OTHER ID NUMBER-COMMERCIAL NUMBER
NY	03179917	Medicaid
VT	1002841	Medicaid
IL	1558394130	Medicaid
ME	1558394130	Medicaid
NH	30009810	Medicaid
MA	0423131	Medicaid
VT	1004936	Medicaid
CT	004128600	Medicaid
NJ	0192091	Medicaid
MA	110022080A	Medicaid
RI	DR00409	Medicaid
DE	1558394130	Medicaid
VA	1558394130	Medicaid
ME	187440000	Medicaid
ME	194400001	Medicaid
NY	02206417	Medicaid
VT	1004936	Medicaid
MD	414499600	Medicaid