Healthcare Provider Details

I. General information

NPI: 1164443214
Provider Name (Legal Business Name): PHARMERICA DRUG SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 W LAWNDALE DR
SALT LAKE CITY UT
84115-2915
US

IV. Provider business mailing address

3802 CORPOREX PARK DR STE 150
TAMPA FL
33619-1125
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-9555
  • Fax: 801-486-4939
Mailing address:
  • Phone: 813-318-6039
  • Fax: 800-825-6408

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 Number7029950-1704
License Number StateUT

VIII. Authorized Official

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