Healthcare Provider Details

I. General information

NPI: 1972057248
Provider Name (Legal Business Name): PHARMACY CORPORATION OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 E 75TH ST STE 322
INDIANAPOLIS IN
46250-2777
US

IV. Provider business mailing address

PO BOX 409244
ATLANTA GA
30384-9244
US

V. Phone/Fax

Practice location:
  • Phone: 800-678-7575
  • Fax: 317-595-6283
Mailing address:
  • Phone: 813-378-6274
  • Fax: 813-318-6346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number60005275A
License Number StateIN

VIII. Authorized Official

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