Provider Demographics
NPI:1215047238
Name:PHARMERICA INSTITUTIONAL PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:PHARMERICA INSTITUTIONAL PHARMACY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-630-7429
Mailing Address - Street 1:3802 CORPOREX PARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-1125
Mailing Address - Country:US
Mailing Address - Phone:813-318-6039
Mailing Address - Fax:
Practice Address - Street 1:38 LOCKE RD
Practice Address - Street 2:UNIT 3
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5416
Practice Address - Country:US
Practice Address - Phone:603-223-0380
Practice Address - Fax:603-223-0347
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X
NH0659 P3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0407500Medicaid
VT1011367Medicaid
NH30702976Medicaid
IL1215047238Medicaid
NJ0643939Medicaid
CT8014147Medicaid
PA102427133-0001Medicaid
ME1215047238Medicaid