MEDICARE: PHARMERICA DRUG SYSTEMS INC

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	3336L0003X	Long Term Care Pharmacy		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4833845	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1982637567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMERICA DRUG SYSTEMS INC

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	:	198 US HIGHWAY 23 N
Second Line	:	SUITE B
City	:	WEBER CITY
State	:	VA
Zip	:	24290-6112
Country	:	US
Telephone Number	:	276-386-3700
Fax Number	:	276-386-6466

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	:	08/22/2020

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