Healthcare Provider Details

I. General information

NPI: 1629634217
Provider Name (Legal Business Name): PHARMACY CORPORATION OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 CHAD DR
EUGENE OR
97408-7343
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 503-626-9436
  • Fax: 844-308-3027
Mailing address:
  • Phone: 813-318-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierRP-0002006-CS
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerBOARD OF PHARMACY
# 2
Identifier500764100
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 3
IdentifierIP-0001818-CS
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerBOARD OF PHARMACY

VIII. Authorized Official

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