Provider Demographics
NPI:1952596363
Name:PHARMACY CORPORATION OF AMERICA
Entity Type:Organization
Organization Name:PHARMACY CORPORATION OF AMERICA
Other - Org Name:EXPRESS CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-630-7429
Mailing Address - Street 1:3802 CORPOREX PARK DR STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-1135
Mailing Address - Country:US
Mailing Address - Phone:813-318-6271
Mailing Address - Fax:813-318-6346
Practice Address - Street 1:945 EDWARDS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3301
Practice Address - Country:US
Practice Address - Phone:571-258-0426
Practice Address - Fax:855-766-6501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010041773336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100773901-0031Medicaid
MD256318500Medicaid
VA0201004177OtherPHARMACY PERMIT
VA1952596363Medicaid
WV1952596363Medicaid
PA100773901-0031Medicaid