Healthcare Provider Details

I. General information

NPI: 1205133733
Provider Name (Legal Business Name): PHARMACY CORPORATION OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21241 N. 23RD AVE.
PHOENIX AZ
85027
US

IV. Provider business mailing address

P.O. BOX 409244
ATLANTA GA
30384-9244
US

V. Phone/Fax

Practice location:
  • Phone: 855-482-1441
  • Fax: 855-583-3477
Mailing address:
  • Phone: 813-378-6274
  • Fax: 817-756-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberY005978
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberY005808
License Number StateAZ

VIII. Authorized Official

Name: THOMAS A CANERIS
Title or Position: VICE PRESIDENT
Credential:
Phone: 502-627-7100