Provider Demographics
NPI:1932197415
Name:PHARMACY CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:PHARMACY CARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-396-9466
Mailing Address - Street 1:545 COTTON GIN ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3552
Mailing Address - Country:US
Mailing Address - Phone:334-396-9466
Mailing Address - Fax:334-386-8496
Practice Address - Street 1:545 COTTON GIN ROAD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3552
Practice Address - Country:US
Practice Address - Phone:334-396-9466
Practice Address - Fax:334-386-8496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMACY CARE ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111630333600000X
AL1113336L0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003087Medicaid