RX-Mart Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH27104 Issued in FL

Legal business name

RX-MART PHARMACY LLC

Doing business as

Rx-Mart Pharmacy

Practice address

665 State Road 207
Suite 101
St Augustine, FL 32084-5938

Phone

(904) 342-2162

Fax

(904) 547-2732

NPI assigned

Nov 6, 2013

Last updated

Jun 2, 2015By 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

Swapna Kondu, RPH

Title

Pic

Phone

(904) 342-2162

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Rx-Mart Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

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.

• Omprakash Boga

  • Pharmacist
  • Winter Park, FL
  • NPI 1437755626
  NPD
• Siva Rama Krishna Kondapalli

  • Pharmacist
  • Lake Mary, FL
  • NPI 1194298901
  NPD
• Sowjanya Shakhamoori

  • Pharmacist
  • Orlando, FL
  • NPI 1487935862
  NPD

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

{
    "created_epoch": "1383696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1366871774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 STATE ROAD 207",
            "address_2": "SUITE 101",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320845938",
            "telephone_number": "904-342-2162",
            "fax_number": "904-547-2732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 STATE ROAD 207",
            "address_2": "SUITE 101",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320845938",
            "telephone_number": "904-342-2162",
            "fax_number": "904-547-2732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RX-MART PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-06",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "KONDU",
        "authorized_official_first_name": "SWAPNA",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "904-342-2162",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH27104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2142731",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010548300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rx-Mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Helena Russell, APRN
• Valerie A Russell, LCSW
• Alexandra Russick, RBT
• Kristin Russo
• Alex Joseph Liboon Rustia, DMD
• Jake Ryan
• Sean Collin Ryan
• S S Marathe MD PA (Medical Specialists PA)
• Yvette Sabater-Lenk, LCSW
• Elizabeth Sabo, PA-C

• Community/Retail Pharmacy in St Augustine, FL
• Providers in St Augustine, 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 Jun 2, 2015; 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.