Pich KTM Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH28291 Issued in FL

Legal business name

PICH KTM CORP

Practice address

11643 Beach Blvd
Unit a
Jacksonville, FL 32246

Phone

(904) 551-5870

Fax

(904) 619-6227

NPI assigned

Jul 9, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Chen Oeur, RPHNPI 1962787861

Title

Pharmacist/Pharmacy Owner

Phone

(904) 551-5870

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Medtown Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

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

• Chen Oeur, PHARMACIST

  • Pharmacist
  • Jacksonville, FL
  • NPI 1962787861
  NPD Authorized official

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

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682899200000",
    "number": "1043626153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11643 BEACH BLVD",
            "address_2": "UNIT A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32246",
            "telephone_number": "904-551-5870",
            "fax_number": "904-619-6227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11643 BEACH BLVD",
            "address_2": "UNIT A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32246",
            "telephone_number": "904-551-5870",
            "fax_number": "904-619-6227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PICH KTM CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-09",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A",
        "authorized_official_last_name": "OEUR",
        "authorized_official_first_name": "CHEN",
        "authorized_official_title_or_position": "PHARMACIST/PHARMACY OWNER",
        "authorized_official_telephone_number": "904-551-5870",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH28291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013879700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147617",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medtown Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medtown Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cristin M Picciano, LCSW
• Kimberly Picciano
• Michael Picco, MD
• Sarah Rose Piccuirro, PHARMD
• Richard A Picerno II, M.D.
• Pich KTM Corp
• Alexandria Pichardo
• Irina Josephovna Pichkhadze, PA-C
• Clay Pickard, DPT
• Dana Pickens, MSN, ARNP, FNP-C

• Community/Retail Pharmacy in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.