MEDICARE: PMC HEALTHCARE PHARMACIES LLC

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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	3336L0003X	Long Term Care Pharmacy	2239	TN

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609987643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PMC HEALTHCARE PHARMACIES LLC

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	:	3588 WORKMAN RD
Second Line	:	SUITE 101
City	:	KNOXVILLE
State	:	TN
Zip	:	37921-5932
Country	:	US
Telephone Number	:	865-558-8733
Fax Number	:	865-588-3460

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/13/2024

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