Healthcare Provider Details

I. General information

NPI: 1396578076
Provider Name (Legal Business Name): PHARMACY CORPORATION OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 FAIRFIELD BLVD STE 103
WALLINGFORD CT
06492-1890
US

IV. Provider business mailing address

PO BOX 85096
CHICAGO IL
60689-5096
US

V. Phone/Fax

Practice location:
  • Phone: 860-829-6575
  • Fax: 860-829-4110
Mailing address:
  • Phone: 847-583-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALLISON BROWN
Title or Position: SECRETARY
Credential:
Phone: 502-630-7429