| Name: | Pharmacy Corporation of America |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Corporation |
| Status: | Exists |
| Entity Number: | 000-883-868 |
| Register Number: | 000883868 |
| Historical Names: |
Beverly Enterprises-Pharmacies, Inc.
|
| ZIP code: | 36104 |
| County: | Montgomery |
| Place of Formation: | California |
| Principal Address: | 3611 QUEEN PALM DRTAMPA, FL 33619 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932110509 | 2006-08-10 | 2014-07-31 | 3802 CORPOREX PARK DR, STE 200, TAMPA, FL, 336191125, US | 7101 US HIGHWAY 90, STE 300, DAPHNE, AL, 365269512, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 813-318-6039 |
| Fax | 8008256408 |
| Phone | +1 877-770-7923 |
| Fax | 8664787909 |
Authorized person
| Name | THOMAS A CANERIS |
| Role | VICE PREISDENT |
| Phone | 5026277100 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | 112833 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 1995938 |
| Issuer | MEDICAID |
| Number | 021966500 |
| State | FL |
| Issuer | MEDICAID |
| Number | 100003728 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY INC | Agent | 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1987-05-22 | Name Change | Beverly Enterprises-Pharmacies, Inc. | Pharmacy Corporation of America |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
