Provider Demographics
NPI:1942233515
Name:PHARMERICA DRUG SYSTEMS INC
Entity Type:Organization
Organization Name:PHARMERICA DRUG SYSTEMS INC
Other - Org Name:COLONIAL DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEBBLES
Authorized Official - Middle Name:
Authorized Official - Last Name:PANGRAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-975-2273
Mailing Address - Street 1:PO BOX 409244
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 E MERCED ST
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:CA
Practice Address - Zip Code:93625-2312
Practice Address - Country:US
Practice Address - Phone:559-834-1606
Practice Address - Fax:559-834-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY460550333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0525153OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA460550Medicaid