Medikon LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH26435 Issued in FL

Legal business name

MEDIKON LLC

Practice address

7077 Normandy Blvd
Suite 5
Jacksonville, FL 32205-6279

Phone

(904) 900-7700

Fax

(904) 551-0794

NPI assigned

Oct 20, 2012

Reactivated

Apr 12, 2018

Organization subpart

No

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

Authorized official

Name

Nishant Patel

Title

Pharmacy Manager

Phone

(904) 900-7700

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Duval Pharmacy 201 Doing business as

Locations

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

{
    "created_epoch": "1350691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523491200000",
    "number": "1194078675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7077 NORMANDY BLVD",
            "address_2": "SUITE 5",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322056279",
            "telephone_number": "904-900-7700",
            "fax_number": "904-551-0794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7077 NORMANDY BLVD",
            "address_2": "SUITE 5",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322056279",
            "telephone_number": "904-900-7700",
            "fax_number": "904-551-0794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIKON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-20",
        "last_updated": "2018-04-12",
        "deactivation_date": "2018-03-06",
        "reactivation_date": "2018-04-12",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "NISHANT",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "904-900-7700"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH26435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008148500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BOARD OF PHARMACY",
            "identifier": "PH26435",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Duval Pharmacy 201",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Apr 12, 2018; 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.