Xtra Care Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH26712 Issued in FL

Legal business name

XTRA CARE PHARMACY INC

Practice address

6520 US Highway 301 S Ste 106
Riverview, FL 33578-4324

Phone

(813) 280-0927

Fax

(813) 677-4500

NPI assigned

Jun 20, 2013

Organization subpart

No

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

Authorized official

Name

Mildred Peterside

Title

Owner/Pic

Phone

(813) 598-0593

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Xtra Care Pharmacy Doing business as

Tax ID family

Xtra Care Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Xtra Care Pharmacy

  • Community/Retail Pharmacy
  • Riverview, FL
  • NPI 1952749632
  NPD tax ID

Networks

• 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)…
• 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)

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

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1184063455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6520 US HIGHWAY 301 S",
            "address_2": "SUITE 106",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335784347",
            "telephone_number": "813-280-0927",
            "fax_number": "813-677-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6520 US HIGHWAY 301 S STE 106",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335784324",
            "telephone_number": "813-280-0927",
            "fax_number": "813-677-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "XTRA CARE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-20",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "PETERSIDE",
        "authorized_official_first_name": "MILDRED",
        "authorized_official_title_or_position": "OWNER/PIC",
        "authorized_official_telephone_number": "813-598-0593"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH26712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009181900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2140629",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Xtra Care Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Xtra Care Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Latrisha Ashley Wright, M.D.
• Sherri Lynn Wyatt, PHD
• Brittany Wylie, PTA
• Danica Wynne
• Xtra Care Pharmacy
• Melodie Yarber, M.A
• Chelsea Yarmy, HIS
• Katelyn V Yawn, RN, CNOR, RNFA
• Carla Antonette Yearwood
• Ian Yetzke, DC

• Community/Retail Pharmacy in Riverview, FL
• Providers in Riverview, 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 Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.