Organization Active NPI

Pharmacy Corporation of America

Doing business as Pharmerica

  • Long Term Care Pharmacy
  • Fridley, MN
National Provider Identifier
1285667865
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
2615480 Issued in MN
Legal business name
PHARMACY CORPORATION OF AMERICA
Doing business as
Pharmerica
Practice address
5255 E River Rd
Suite 204
Fridley, MN 55421-1026
Phone
(763) 571-2220
Fax
(763) 571-3311
NPI assigned
Jul 8, 2006
Organization subpart
Yes
Parent organization
PHARMERICA CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Allison L. Brown
Title
Secretary
Phone
(502) 630-7429

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Long Term Care Pharmacy 3336L0003X 2615480 MN Primary

Addresses

Primary practice location

5255 E River Rd
Suite 204
Fridley, MN 55421-1026

Mailing address

3802 Corporex Park Dr Ste 150
Tampa, FL 33619-1135
Phone (813) 318-6039

Other identifiers 11

IdentifierTypeStateIssuer
2406785MedicaidMI
661057900MedicaidMN
9151500MedicaidSD
2406785OtherOTHER ID NUMBER-COMMERCIAL NUMBER
939108MedicaidIA
2406785MedicaidIA
1285667865MedicaidWI
7M1548MedicaidSC
33037000MedicaidWI
8532032MedicaidSD
200526100AMedicaidIN

Other names 1

  • PHARMERICA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930013003 MN DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 1850381807 Practice locations: Fridley, MN
O20210312001903 MN Part B Supplier - Mass Immunization (Roster Biller Only) 1850381807 Practice locations: Fridley, MN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Pharmerica5255 E River Rd, Fridley, MN 55421-1005(763) 571-2220 Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Jan 18, 2020

National Provider Directory

National Provider Directory
Tax ID family
Beverly Enterrises58 organizations share this tax ID, including this one

Member of 4

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Heritage at Lowman Rehabilitation and HealthcareWhite Rock, SC, CCN 425100 Skilled nursing facility Adp of the SNF Oct 31, 2013
Maplewood CenterWest Allis, WI, CCN 525069 Skilled nursing facility Adp of the SNF Jan 31, 2019
Rice Estate Rehabilitation and HealthcareColumbia, SC, CCN 425387 Skilled nursing facility Adp of the SNF Oct 31, 2013
Sharon Care CenterCentralia, WA, CCN 505429 Skilled nursing facility Adp of the SNF Jan 1, 2023
Camden National BankBerlin, NH, CCN 305102 Skilled nursing facility Adp of the SNF Jan 1, 2022
PharmericaPhiladelphia, PA, CCN 396141 Skilled nursing facility Adp of the SNF Jan 25, 2017
Ashford HallIrving, TX, CCN 455748 Skilled nursing facility Adp of the SNF Sep 29, 2015
Kau HospitalKapolei, HI, CCN 125070 Skilled nursing facility Operational/Managerial Control Feb 4, 2025

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1285667865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3802 CORPOREX PARK DR STE 150",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336191135",
            "telephone_number": "813-318-6039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5255 E RIVER RD",
            "address_2": "SUITE 204",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554211026",
            "telephone_number": "763-571-2220",
            "fax_number": "763-571-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMACY CORPORATION OF AMERICA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHARMERICA CORPORATION",
        "enumeration_date": "2006-07-08",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "502-630-7429"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MN",
            "license": "2615480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2406785",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "661057900",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9151500",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2406785",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "939108",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2406785",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285667865",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7M1548",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33037000",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8532032",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200526100A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHARMERICA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PHARMERICA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fridley, MN

Sources for this page

Verify at the official NPI Registry.