Provider Demographics
NPI:1609036995
Name:PHARMERICA INC
Entity Type:Organization
Organization Name:PHARMERICA INC
Other - Org Name:PHARMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
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 1:321 W BEN WHITE BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7035
Mailing Address - Country:US
Mailing Address - Phone:512-443-8984
Mailing Address - Fax:512-443-9220
Practice Address - Street 1:321 W BEN WHITE BLVD
Practice Address - Street 2:103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7035
Practice Address - Country:US
Practice Address - Phone:512-443-8984
Practice Address - Fax:512-443-8984
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3500143336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350014Medicaid