Provider Demographics
NPI:1184171704
Name:PHARMACY CORPORATION OF AMERICA
Entity type:Organization
Organization Name:PHARMACY CORPORATION OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARIVIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-627-7404
Mailing Address - Street 1:18110 SE 34TH ST STE 290
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9440
Mailing Address - Country:US
Mailing Address - Phone:800-330-3665
Mailing Address - Fax:800-982-2730
Practice Address - Street 1:18110 SE 34TH ST BLDG 2
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9440
Practice Address - Country:US
Practice Address - Phone:800-330-3665
Practice Address - Fax:800-982-2730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-01
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 3336C0003X, 3336H0001X, 3336M0002X, 3336S0011X, 333600000X
WAPHAR.CF.60670763336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163906OtherPK