St Judes Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH24077 Issued in FL

Legal business name

ST JUDES PHARMACY INC

Doing business as

St Judes Pharmacy Inc.

Practice address

1202 NE Pine Island Rd
Ste IV
Cape Coral, FL 33909-2197

Phone

(239) 673-7777

Fax

(239) 673-7778

NPI assigned

Jun 2, 2009

Last updated

Aug 12, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jorge Otano

Title

Owner/President

Phone

(239) 673-7777

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• St Judes Pharmacy Inc. Doing business as

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

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281571200000",
    "number": "1235365495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 NE PINE ISLAND RD",
            "address_2": "UNIT IV",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339092197",
            "telephone_number": "239-673-7777",
            "fax_number": "239-673-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 NE PINE ISLAND RD",
            "address_2": "STE IV",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339092197",
            "telephone_number": "239-673-7777",
            "fax_number": "239-673-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDES PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-02",
        "last_updated": "2010-08-12",
        "status": "A",
        "authorized_official_last_name": "OTANO",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "239-673-7777"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH24077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001426500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1045841",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Judes Pharmacy Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sports Specialty & Rehabilitation Center Inc
• Julie Spring, CRNA
• Benjamin Robert Sprosty, APRN
• Reeba Srivastava, PHARMD.
• SS Lee I Community HC LLC (Rehab & Healthcare Center of Cape Coral)
• Misti St Pierre, COTA/L 14505
• Denise A Staerker, CNM
• Summer Stagman
• Jasmine Nicole Stanze, M.S., CCC-SLP
• Sarai Starkey, RBT

• Community/Retail Pharmacy in Cape Coral, FL
• Providers in Cape Coral, 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 Aug 12, 2010; 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.