PSJ Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH23958 Issued in FL

Legal business name

PSJ PHARMACY LLC

Practice address

6801 N US Highway 1 Ste 1
Cocoa, FL 32927-5095

Phone

(321) 637-0911

Fax

(321) 639-0856

NPI assigned

Apr 8, 2009

Organization subpart

No

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

Authorized official

Name

Rajesh Patel, RPHNPI 1790050946

Title

Manager

Phone

(407) 488-6851

Specialties & licenses 6

Addresses

Other identifiers 3

Other names 1

• Port St John Discount Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in FL3 enrollments

Enrollment records 3

Networks

• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Practitioners 3

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

• Rajesh Arvindbhai Patel, PHARMACIST

  • Pharmacist
  • Cocoa, FL
  • NPI 1790050946
  NPD (past) Authorized official
• Bhavin Ratilal Dhaduk

  • Pharmacist
  • Cocoa, FL
  • NPI 1659646842
  NPD (past)
• Ronakkumar Patel

  • Pharmacist
  • Cocoa, FL
  • NPI 1649640178
  NPD (past)

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

{
    "created_epoch": "1239148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427673600000",
    "number": "1053554980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 N US HIGHWAY 1 STE 1",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329275095",
            "telephone_number": "321-637-0911",
            "fax_number": "321-639-0856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 N US HIGHWAY 1 STE 1",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329275095",
            "telephone_number": "321-637-0911",
            "fax_number": "321-639-0856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSJ PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-08",
        "last_updated": "2015-03-30",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "RAJESH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "407-488-6851",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH23958",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001149900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2119675",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001149901",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port St John Discount Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heather Probert
• Linda Lee Prough, LPN
• Allison Nicole Pruett
• Joseph Prusas IV, MA CCC-SLP
• PSJ Pediatrics, LLC
• PSJ Pharmacy LLC
• Publix Super Markets Inc
• Publix Super Markets Inc
• QHDS LLC
• Quiant, PLLC

• All providers in Cocoa, FL
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2015; 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.