Provider Demographics
NPI:1922031590
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 - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-630-7429
Mailing Address - Street 1:3802 CORPOREX PARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-1125
Mailing Address - Country:US
Mailing Address - Phone:813-318-6039
Mailing Address - Fax:
Practice Address - Street 1:1100 WILSON WAY SE
Practice Address - Street 2:SUITE 500
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-7210
Practice Address - Country:US
Practice Address - Phone:770-432-1621
Practice Address - Fax:800-722-3599
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
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GAPHRE0068063336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA501299Medicaid
GA00255516AMedicaid
1136298OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TN1136298Medicaid
VA1922031590Medicaid
IA0501299Medicaid
TX599047Medicaid
GA00255516AMedicaid
VA1922031590Medicaid
GA00255516AMedicaid