Provider Demographics
NPI:1134587181
Name:PHARMACY CORPORATION OF AMERICA
Entity type:Organization
Organization Name:PHARMACY CORPORATION OF AMERICA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-394-2100
Mailing Address - Street 1:805 N WHITTINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-7101
Mailing Address - Country:US
Mailing Address - Phone:502-394-2100
Mailing Address - Fax:855-217-7498
Practice Address - Street 1:4423 PHEASANT RIDGE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-5299
Practice Address - Country:US
Practice Address - Phone:844-661-7240
Practice Address - Fax:844-661-7241
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA CORPORATE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-05
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010046763336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAFE6467826OtherDEA
VA0202207482OtherPHARMACY PERMIT