Healthcare Provider Details

I. General information

NPI: 1376576959
Provider Name (Legal Business Name): PHARMERICA DRUG SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 44TH ST SE SUITE A
GRAND RAPIDS MI
49512-4080
US

IV. Provider business mailing address

3802 CORPOREX PARK DR STE 150
TAMPA FL
33619-1135
US

V. Phone/Fax

Practice location:
  • Phone: 616-954-6833
  • Fax: 616-954-3806
Mailing address:
  • Phone: 502-627-7000
  • Fax: 502-627-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number5301007793
License Number StateMI

VIII. Authorized Official

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