PHARMACY CORPORATION OF AMERICA

Provider Demographics

• NPI: 1730112301
• 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
• 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
• Practice Address - Street 1: 6330 E 75TH ST
• Practice Address - Street 2: SUITE 322
• Practice Address - City: INDIANAPOLIS
• Practice Address - State: IN
• Practice Address - Zip Code: 46250-2777
• Practice Address - Country: US
• Practice Address - Phone: 317-595-6270
• Practice Address - Fax: 317-595-6283
• 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, 3336H0001X
IN	60005275A	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	3336H0001X	Suppliers	Pharmacy	Home Infusion Therapy Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
AK	1671353	Medicaid
CT	1730112301	Medicaid
ID	1730112301	Medicaid
NE	10025898302	Medicaid
IN	100292390A	Medicaid
	1529607	Other	OTHER ID NUMBER-COMMERCIAL NUMBER
NV	1730112301	Medicaid
MO	600045200	Medicaid
CO	1730112301	Medicaid
CA	1730112301	Medicaid
AZ	262456	Medicaid
FL	10555500	Medicaid
KY	7100484140	Medicaid
NJ	0608530	Medicaid
IL	9538500000000	Medicaid
NC	1730112301	Medicaid
IA	1730112301	Medicaid
MD	546608301	Medicaid
AR	UNK	Medicaid
MI	1730112301	Medicaid
OH	2139215	Medicaid