Brevard Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH30509 Issued in FL

Legal business name

BREVARD PHARMACY LLC

Practice address

6250 N US Highway 1
Cocoa, FL 32927-4926

Phone

(321) 305-6975

Fax

(321) 305-6978

NPI assigned

Mar 13, 2017

Organization subpart

No

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

Authorized official

Name

Rajesh PatelNPI 1790050946

Title

Owner

Phone

(407) 488-6851

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• Port St John Discount Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Tax ID family

Brevard Pharmacy LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Brevard Pharmacy L.L.C.

  • Long Term Care Pharmacy
  • Rockledge, FL
  • NPI 1174168322
  NPD tax ID
• Brevard Pharmacy LLC

  • Community/Retail Pharmacy
  • Cocoa, FL
  • NPI 1467752691
  NPD tax ID

Locations

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 1

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

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

{
    "created_epoch": "1489363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489363200000",
    "number": "1316488281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6250 N US HIGHWAY 1",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329274926",
            "telephone_number": "321-305-6975",
            "fax_number": "321-305-6978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6250 N US HIGHWAY 1",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329274926",
            "telephone_number": "321-305-6975",
            "fax_number": "321-305-6978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-13",
        "last_updated": "2017-03-13",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "RAJESH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-488-6851"
    },
    "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": "PH30509",
            "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
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003226300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2168151",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port St John Discount Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brevard Health Alliance Inc
• Brevard Health Alliance Inc
• Brevard Health Alliance Inc
• Brevard Health Alliance Inc
• Brevard Independent Supportive Services LLC
• Brevard Pharmacy LLC
• Brevard Physicians PA
• Denise Briggs
• Brodnan Medical LLC
• Alexis Nikole Brown

• Community/Retail Pharmacy in Cocoa, FL
• Providers in Cocoa, 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 Mar 13, 2017; 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.