MEDICARE: PHARMERICA DRUG SYSTEMS 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	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	530103923	OTHER	MI	PHARMACY

General Provider Information

NPI Number	:	1750233151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMERICA DRUG SYSTEMS LLC

Provider Business Mailing Address
First Line	:	805 N WHITTINGTON PKWY STE 400
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7102
Country	:	US
Telephone Number	:	502-627-7917
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 E 12 MILE RD STE A
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48092-2593
Country	:	US
Telephone Number	:	586-231-2441
Fax Number	:	586-231-2442

Authorized Official
Title or Position	:	PHARMACY LICENSING MANAGER
Name	:	DASIA PENDLETON
Credential	:
Telephone Number	:	502-630-7494

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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Directions to “PHARMERICA DRUG SYSTEMS LLC ” Practice Location

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