PHARMACY CORPORATION OF AMERICA

Provider Demographics

• NPI: 1801802210
• Name: PHARMACY CORPORATION OF AMERICA
• Entity type: Organization
• Organization Name: PHARMACY CORPORATION OF AMERICA
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: VICE PRESIDENT
• Authorized Official - Prefix: MR
• Authorized Official - First Name: THOMAS
• Authorized Official - Middle Name: A
• Authorized Official - Last Name: CANERIS
• Authorized Official - Phone: 502-627-7100
• 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
• Practice Address - Street 1: 1100 WILSON WAY
• Practice Address - Street 2: STE 500
• Practice Address - City: SMYRNA
• Practice Address - State: GA
• Practice Address - Zip Code: 30082
• 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: 2006-07-31
• Last Update Date: 2013-01-24

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	332BP3500X	Suppliers	Durable Medical Equipment & Medical Supplies	Parenteral & Enteral Nutrition

Provider Identifiers

State	Identifier ID	ID Type	Issuer
LA	1558559	Medicaid
IN	200264800A	Medicaid
GA	000255516B	Medicaid
KS	100080240D	Medicaid
SD	9151500	Medicaid
AL	009610640	Medicaid
FL	106298101	Medicaid
ND	55365	Medicaid
MO	622449114	Medicaid
VA	009149368	Medicaid
WI	33037000	Medicaid
NC	7701221	Medicaid
OH	0392427	Medicaid
TX	150921801	Medicaid
CT	1801802210	Medicaid
TN	3541753	Medicaid
KY	9000795600	Medicaid
RI	PC72436	Medicaid
DC	033685800	Medicaid
NH	30009810	Medicaid
MN	377417000	Medicaid
MN	661057900	Medicaid
ID	8082344	Medicaid
MS	00040355	Medicaid
PA	1007739010019	Medicaid
OK	200035360C	Medicaid
MI	4914077	Medicaid
NC	7701221	Medicaid
ND	55365	Medicaid
OH	0392427	Medicaid