NPIMap

Organization Active NPI

PSJ Pharmacy LLC

Doing business as Port St. John Discount Pharmacy

  • Long Term Care Pharmacy
  • Cocoa, FL
National Provider Identifier
1396184933
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
PSJ PHARMACY LLC
Doing business as
Port St. John Discount Pharmacy
Practice address
6801 N US Highway 1 Ste 1
Cocoa, FL 32927-5095
Phone
(321) 637-0911
Fax
(321) 639-0856
NPI assigned
Jun 17, 2013
Last updated
Mar 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Authorized official

Name
Rajesh Arvindbhai Patel, RPHNPI 1790050946
Title
Manager/Pharmacist
Phone
(321) 637-0911

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

6801 N US Highway 1 Ste 1
Cocoa, FL 32927-5095

Mailing address

6801 N US Highway 1 Ste 1
Cocoa, FL 32927-5095
Phone (321) 637-0911

Other identifiers 1

IdentifierTypeStateIssuer
001149901MedicaidFL

Other names 1

  • Port St. John Discount Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

6801 N US Highway 1
Ste 1
Port St John, FL 32927
Phone (321) 637-0911

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 & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1371427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1396184933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 N US HIGHWAY 1 STE 1",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329275095",
            "telephone_number": "321-637-0911",
            "fax_number": "321-639-0856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 N US HIGHWAY 1 STE 1",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329275095",
            "telephone_number": "321-637-0911",
            "fax_number": "321-639-0856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSJ PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-17",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "RAJESH",
        "authorized_official_middle_name": "ARVINDBHAI",
        "authorized_official_title_or_position": "MANAGER/PHARMACIST",
        "authorized_official_telephone_number": "321-637-0911",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001149901",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port St. John Discount Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Port St. John Discount Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cocoa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; 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.