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	333600000X	Pharmacy	PHY579	HI
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1202302	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1568495133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY CORPORATION OF AMERICA

Provider Business Mailing Address
First Line	:	PO BOX 409244
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-9244
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 E LIPOA ST
Second Line	:	SPACE 23A
City	:	KIHEI
State	:	HI
Zip	:	96753-8148
Country	:	US
Telephone Number	:	808-879-8499
Fax Number	:	808-874-0800

Authorized Official
Title or Position	:	CONTRACT ADMINISTRATOR
Name	:	PEBBLES PANGRAZIO
Credential	:
Telephone Number	:	877-975-2273

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	09/11/2025

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Directions to “PHARMACY CORPORATION OF AMERICA ” Practice Location

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