Broadway Discount Pharmacy LLC

Key facts

NPI: 1215439609
Entity type: Organization (NPI type 2)
Primary specialty: Community/Retail Pharmacy 3336C0003X
License: PH31216 (FL)
Legal business name: BROADWAY DISCOUNT PHARMACY LLC
Practice address: 1765 N Broadway Ave
Bartow, FL 33830-3104
Phone: (863) 537-7656
Fax: (863) 537-7927
NPI assigned: Mar 1, 2018
Organization subpart: No

Authorized official

Name: Samir Dhaduk
Title: Owner
Phone: (201) 916-7123

Practitioners 1

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

Alpeshkumar Bhailalbhai Patel Pharmacist · Bartow, FL · NPI 1528606217

NPD (past)

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Supplier	Supplies	Medicare assignment
Broadway Discount Pharmacy 1765 N Broadway Ave, Bartow, FL 33830-3104 · (863) 537-7656	Epoetin\|Immunosuppressive Drugs\|Infusion Drugs\|Nebulizer Drugs\|Oral Anticancer Drugs\|Oral Antiemetic Drugs	Accepts assignment Participating since May 1, 2019

Medicare participation

Medicare fee-for-service enrollment: Enrolled in FL

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20191122001195	FL	DME Supplier - Pharmacy	6709118193	Practice locations: Bartow, FL

National Provider Directory

Locations

1765 N Broadway Ave
Bartow, FL 33830
Phone (863) 519-9837

Networks

Freedom Health HMO Network
Plans: 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 Network
Plans: 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)

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Community/Retail Pharmacy	3336C0003X	PH31216	FL	Yes

Addresses

Primary practice location

1765 N Broadway Ave
Bartow, FL 33830-3104

Mailing address

4040 Sunset Lake Dr
Lakeland, FL 33810-2841
Phone (201) 916-7123

Other names

Broadway Discount Pharmacy Doing business as

Other providers in Bartow, FL

All providers in Bartow, FL · Community/Retail Pharmacy in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.