Medoz Pharmacy of Polk LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH28722 Issued in FL

Legal business name

MEDOZ PHARMACY OF POLK LLC

Practice address

40230 US Highway 27 N
Suite 100-110
Davenport, FL 33837-2636

Phone

(855) 633-6948

Fax

(844) 329-6348

NPI assigned

Nov 24, 2014

Last updated

Aug 25, 2022By 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

Abraham Mermelstein

Title

Managing Member

Phone

(732) 267-7782

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• f/k/a Medoz Pharmacy of Polk Inc Former legal business name

Locations

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 Máximo (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)

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Udaykumar J Desai, B.PHARM

  • Pharmacist
  • Davenport, FL
  • NPI 1487612693
  NPD

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

{
    "created_epoch": "1416787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1346647005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40230 US HIGHWAY 27 N",
            "address_2": "SUITE 100-110",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338372636",
            "telephone_number": "855-633-6948",
            "fax_number": "844-329-6348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40230 US HIGHWAY 27 N",
            "address_2": "SUITE 100-110",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338372636",
            "telephone_number": "855-633-6948",
            "fax_number": "844-329-6348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDOZ PHARMACY OF POLK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-24",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "MERMELSTEIN",
        "authorized_official_first_name": "ABRAHAM",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "732-267-7782"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "PH28722",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH28722",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "FL",
            "license": "PS28722",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY STATE LICENSE NUMBER",
            "identifier": "PH28722",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014712100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "f/k/a Medoz Pharmacy of Polk Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Medical Home Alliance LLC (IMA Medical Group - Degnan)
• Marko Anthony Medina, PTA
• Mya Lucero Medina, CCC-SLP
• Tanairy Medina
• Medoz Pharmacy of Polk Inc
• Robyn Tracy Meers, APRN
• Andrew Dean Meikle, MD
• Jennifer Mejia
• Carmen D Melendez Torres
• Yvonne Mello, RN

• Community/Retail Pharmacy in Davenport, FL
• Providers in Davenport, 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 25, 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.