Provider Demographics
NPI:1760585871
Name:AMERICARE PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:AMERICARE PHARMACY SERVICES LLC
Other - Org Name:PEGASUS EXPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER AND COO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-528-0070
Mailing Address - Street 1:621 E 15TH ST STE D
Mailing Address - Street 2:SUITE D
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1875
Mailing Address - Country:US
Mailing Address - Phone:931-528-0070
Mailing Address - Fax:866-471-1114
Practice Address - Street 1:621 E 15TH ST STE D
Practice Address - Street 2:SUITE D
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1875
Practice Address - Country:US
Practice Address - Phone:931-528-0070
Practice Address - Fax:866-471-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN41823336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200421130AMedicaid
TN1760585871Medicaid
MO606257301Medicaid
2094722OtherPK
IA1760585871Medicaid