Provider Demographics
NPI:1316959885
Name:PMC PHARMACY SERVICES, INC.
Entity type:Organization
Organization Name:PMC PHARMACY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANERIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-627-7100
Mailing Address - Street 1:222 E HUNTINGTON DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-8006
Mailing Address - Country:US
Mailing Address - Phone:800-533-9752
Mailing Address - Fax:626-256-6016
Practice Address - Street 1:222 E HUNTINGTON DR
Practice Address - Street 2:SUITE 111
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-8006
Practice Address - Country:US
Practice Address - Phone:800-533-9752
Practice Address - Fax:626-256-6016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-13
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X
CAPHY487053336L0003X
CAPHY471073336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316959885Medicaid
CAPHA471070Medicaid
0348420077Medicare NSC