Basic Information
Provider Information
NPI: 1841223419
EntityType: 2
ReplacementNPI:  
OrganizationName: PHARMACY CORPORATION OF AMERICA
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: PHARMERICA
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3802 CORPOREX PARK DR STE 150
Address2:  
City: TAMPA
State: FL
PostalCode: 336191135
CountryCode: US
TelephoneNumber: 8133186039
FaxNumber:  
Practice Location
Address1: 8 FAIRFIELD BLVD STE 103
Address2:  
City: WALLINGFORD
State: CT
PostalCode: 064921890
CountryCode: US
TelephoneNumber: 8608296575
FaxNumber: 8608294110
Other Information
ProviderEnumerationDate: 07/08/2006
LastUpdateDate: 11/02/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: REED
AuthorizedOfficialFirstName: STEVEN
AuthorizedOfficialMiddleName: S.
AuthorizedOfficialTitleorPosition: VICE PRESIDENT
AuthorizedOfficialTelephone: 5023942100
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: PHARMERICA CORPORATION
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/02/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332B00000X  N SuppliersDurable Medical Equipment & Medical Supplies 
3336L0003XPCY1654CTY SuppliersPharmacyLong Term Care Pharmacy

ID Information
IDTypeStateIssuerDescription
00412860005CT MEDICAID
0155264305NY MEDICAID
110020636A05MA MEDICAID
616003005RI MEDICAID
101625005VT MEDICAID
00412627405CT MEDICAID
101508905VT MEDICAID
184122341905CT MEDICAID
071621101 OTHER ID NUMBER-COMMERCIAL NUMBEROTHER


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