Provider Demographics
NPI:1205133733
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:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANERIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-627-7100
Mailing Address - Street 1:P.O. 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:813-378-6274
Mailing Address - Fax:817-756-1101
Practice Address - Street 1:21241 N. 23RD AVE.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:855-482-1441
Practice Address - Fax:855-583-3477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY005978333600000X
AZY0058083336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128904OtherPK