Healthcare Provider Details

I. General information

NPI: 1942156237
Provider Name (Legal Business Name): PHARMERICA LONG-TERM CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 COUNTRY CLUB RD
SANTA TERESA NM
88008-9695
US

IV. Provider business mailing address

10002 PRINCESS PALM AVE STE 106
TAMPA FL
33619-1357
US

V. Phone/Fax

Practice location:
  • Phone: 575-888-3466
  • Fax: 575-888-3452
Mailing address:
  • Phone: 813-316-6656
  • Fax: 800-825-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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