=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841223419
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARMACY CORPORATION OF AMERICA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 02/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 FAIRFIELD BLVD STE 103
-----------------------------------------------------
City | WALLINGFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06492-1890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-829-6575
-----------------------------------------------------
Fax | 860-829-4110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3802 CORPOREX PARK DR STE 150
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33619-1135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-318-6039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | ALLISON L. BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-630-7429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | PCY1654
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------