MEDICARE: PHARMACY CORPORATION OF AMERICA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy	1001503	SD
3	3336C0003X	Community/Retail Pharmacy
4	3336L0003X	Long Term Care Pharmacy	100-1928	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	4303638	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174556757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY CORPORATION OF AMERICA

Provider Business Mailing Address
First Line	:	3802 CORPOREX PARK DR
Second Line	:	STE 200
City	:	TAMPA
State	:	FL
Zip	:	33619-1125
Country	:	US
Telephone Number	:	813-318-6039
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 5TH ST
Second Line	:	SUITE 109
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6014
Country	:	US
Telephone Number	:	605-342-8132
Fax Number	:	605-343-3326

Authorized Official
Title or Position	:	SECRETARY
Name	:	ALLISON L. BROWN
Credential	:
Telephone Number	:	502-630-7429

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	02/13/2024

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Directions to “PHARMACY CORPORATION OF AMERICA ” Practice Location

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