Healthcare Provider Details

I. General information

NPI: 1184171704
Provider Name (Legal Business Name): PHARMACY CORPORATION OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18110 SE 34TH ST BLDG 2
VANCOUVER WA
98683-9440
US

IV. Provider business mailing address

18110 SE 34TH ST STE 290
VANCOUVER WA
98683-9440
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-3665
  • Fax: 800-982-2730
Mailing address:
  • Phone: 800-330-3665
  • Fax: 800-982-2730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHAR.CF.6067076
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN A LARIVIERE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 502-627-7404