Healthcare Provider Details

I. General information

NPI: 1609036995
Provider Name (Legal Business Name): PHARMERICA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W BEN WHITE BLVD 103
AUSTIN TX
78704-7035
US

IV. Provider business mailing address

321 W BEN WHITE BLVD STE 103
AUSTIN TX
78704-7035
US

V. Phone/Fax

Practice location:
  • Phone: 512-443-8984
  • Fax: 512-443-8984
Mailing address:
  • Phone: 512-443-8984
  • Fax: 512-443-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number350014
License Number StateTX

VIII. Authorized Official

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