MEDICARE: PHARMERICA DRUG SYSTEMS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	LSC99079	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336L0003X	Long Term Care Pharmacy	PHY48709	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0595287	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114950789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMERICA DRUG SYSTEMS LLC

Provider Business Mailing Address
First Line	:	3802 CORPOREX PARK DR STE 150
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-1135
Country	:	US
Telephone Number	:	502-394-2100
Fax Number	:	502-627-7401

Provider Business Practice Location Address
First Line	:	11205 KNOTT AVE
Second Line	:	SUITE C
City	:	CYPRESS
State	:	CA
Zip	:	90630-5489
Country	:	US
Telephone Number	:	714-891-5145
Fax Number	:	714-901-2468

Authorized Official
Title or Position	:	SECRETARY
Name	:	ALLISON L. BROWN
Credential	:
Telephone Number	:	502-630-7429

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	02/13/2024

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Directions to “PHARMERICA DRUG SYSTEMS LLC ” Practice Location

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