Provider Demographics
NPI:1891728473
Name:PHARMERICA DRUG SYSTEMS LLC
Entity type:Organization
Organization Name:PHARMERICA DRUG SYSTEMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
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 1:305 SEABOARD LN
Practice Address - Street 2:SUITE 318
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8287
Practice Address - Country:US
Practice Address - Phone:615-771-8790
Practice Address - Fax:615-771-8914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00470332B00000X
TN00000004703336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4422995OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MI1891728473Medicaid
TNQ045252Medicaid
MI1891728473Medicaid
AL100550024Medicaid
MD407739300Medicaid
NY02620859Medicaid
GA081973233AMedicaid
4422995OtherOTHER ID NUMBER-COMMERCIAL NUMBER
SD8535460Medicaid
MT1891728473Medicaid
CT003125681Medicaid
AR154629407Medicaid
WV6003125001Medicaid
PA1007511810038Medicaid
KY7100049200Medicaid
DC036103500Medicaid
OK200048140AMedicaid
OH2626402Medicaid
NC445795Medicaid
RIPD64256Medicaid
TN4422995Medicaid
1246490010Medicare NSC