Healthcare Provider Details

I. General information

NPI: 1326064213
Provider Name (Legal Business Name): PHARMACY CORPORATION OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11205 KNOTT AVE SUITE E
CYPRESS CA
90630-5489
US

IV. Provider business mailing address

1100 WILSON WAY SE SUITE 500
SMYRNA GA
30082-7248
US

V. Phone/Fax

Practice location:
  • Phone: 714-890-8469
  • Fax: 800-478-4526
Mailing address:
  • Phone: 800-678-7221
  • Fax: 800-722-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

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