Brevard Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH30509 Issued in FL

Legal business name

BREVARD PHARMACY LLC

Doing business as

Port St John Discount Pharmacy

Practice address

6250 N US Highway 1
Cocoa, FL 32927-4926

Phone

(321) 305-6975

Fax

(321) 305-6978

NPI assigned

Oct 21, 2010

Last updated

Mar 6, 2017By 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

Chandrikaben Patel, RPH

Title

Owner

Phone

(407) 488-6851

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• Port St John Discount Pharmacy Doing business as

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

  dba Port St John Discount Pharmacy

  • Community/Retail Pharmacy
  • Cocoa, FL
  • NPI 1316488281
  NPD tax ID

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.

• Rajesh Arvindbhai Patel, PHARMACIST

  • Pharmacist
  • Cocoa, FL
  • NPI 1790050946
  NPD (past)

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

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488758400000",
    "number": "1467752691",
    "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": "2010-10-21",
        "last_updated": "2017-03-06",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "CHANDRIKABEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-488-6851",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "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": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2127271",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003226301",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003226300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port St John Discount Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brevard Health Alliance Inc (BHA Port St. John Pharmacy)
• Brevard Health Alliance Inc (Family Promise Firehouse Clinic)
• Brevard Health Alliance Inc
• Brevard Independent Supportive Services LLC
• Brevard Pharmacy LLC (Port St John Discount Pharmacy)
• Brevard Physicians PA
• Denise Briggs
• Brodnan Medical LLC
• Alexis Nikole Brown
• David 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 6, 2017; 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.