Pine Brook Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH24082 Issued in FL

Legal business name

PINE BROOK PHARMACY LLC

Doing business as

PINE BROOK PHARMACY

Practice address

14111 Cortez Blvd
Brooksville, FL 34613-2707

Phone

(352) 610-4347

Fax

(352) 610-4349

NPI assigned

May 28, 2009

Organization subpart

No

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

Authorized official

Name

Heena Thakkar

Title

President

Phone

(813) 454-3426

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• PINE BROOK PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gautam Thakkar, RPH

  • Pharmacist
  • Lutz, FL
  • NPI 1194914572
  NPD
• Jingwen Huang

  • Pharmacist
  • New Smyrna Beach, FL
  • NPI 1275001935
  NPD (past)
• Manish Mehta, PHARMACIST

  • Pharmacist
  • Spring Hill, FL
  • NPI 1336660919
  NPD (past)
• Isabel Pietras

  • Pharmacist
  • Brooksville, FL
  • NPI 1083280796
  NPD (past)
• Carmen Wise

  • Pharmacist
  • Brooksville, FL
  • NPI 1154984672
  NPD (past)

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

{
    "created_epoch": "1243468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643241600000",
    "number": "1558596932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14111 CORTEZ BLVD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346132707",
            "telephone_number": "352-610-4347",
            "fax_number": "352-610-4349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14111 CORTEZ BLVD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346132707",
            "telephone_number": "352-610-4347",
            "fax_number": "352-610-4349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE BROOK PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-28",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A",
        "authorized_official_last_name": "THAKKAR",
        "authorized_official_first_name": "HEENA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-454-3426"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH24082",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6669650001",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2120453",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PINE BROOK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PINE BROOK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Physician Partners Network PA
• Mallik A Piduru, M.D.
• Edward Russell Pierce
• Isabel Pietras
• Debra Jean Pilla
• Pine Brook Pharmacy LLC
• Jesus Manuel Pinero Jr.
• Terry P Pitts, ARNP
• Joseph Raymond Plouffe, DO
• Stephen Plummer, ARNP

• Community/Retail Pharmacy in Brooksville, FL
• Providers in Brooksville, 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 Jan 27, 2022; 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.