Healthcare Provider Details

I. General information

NPI: 1336150580
Provider Name (Legal Business Name): PHARMERICA MIDWEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 99TH ST
URBANDALE IA
50322-3840
US

IV. Provider business mailing address

3802 CORPOREX PARK DR STE 150
TAMPA FL
33619-1125
US

V. Phone/Fax

Practice location:
  • Phone: 515-331-7756
  • Fax: 515-331-7760
Mailing address:
  • Phone: 813-318-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number742
License Number StateIA

VIII. Authorized Official

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