Eckerds Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

ECKERDS PHARMACY LLC

Doing business as

Vistara Specialty Pharmacy

Practice address

4404 66TH St N
Kenneth City, FL 33709-4922

Phone

(727) 513-1107

Fax

(727) 513-1109

NPI assigned

Mar 10, 2020

Last updated

Jan 18, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

ECKERDS PHARMACY LLCAs reported in NPPES

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

Authorized official

Name

Bhaveshkumar PatelNPI 1508469040

Title

Authorized Officer

Phone

(813) 900-4995

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• VISTARA SPECIALTY PHARMACY Doing business as

Part of

Eckerds Pharmacy LLC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Eckerds Pharmacy LLC

  dba Vistara Specialty Pharmacy

  • Community/Retail Pharmacy
  • Kenneth City, FL
  • NPI 1922577832
  NPPES parent name

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.

• Bhaveshkumar Patel

  • Pharmacist
  • Riverview, FL
  • NPI 1508469040
  NPD Authorized official

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

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1578198560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4404 66TH ST N",
            "city": "KENNETH CITY",
            "state": "FL",
            "postal_code": "337094922",
            "telephone_number": "727-513-1107",
            "fax_number": "727-513-1109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4404 66TH ST N",
            "city": "KENNETH CITY",
            "state": "FL",
            "postal_code": "337094922",
            "telephone_number": "727-513-1107",
            "fax_number": "727-513-1109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECKERDS PHARMACY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ECKERDS PHARMACY LLC",
        "enumeration_date": "2020-03-10",
        "last_updated": "2024-01-18",
        "certification_date": "2023-12-29",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "BHAVESHKUMAR",
        "authorized_official_title_or_position": "AUTHORIZED OFFICER",
        "authorized_official_telephone_number": "813-900-4995"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101899100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VISTARA SPECIALTY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Creative Behavior Solutions, LLC
• Imrena Dedic, BCBA
• Jeri Devale, PH.D
• Madhuri Duggirala
• Shamik Dwivedi, D.O., M.P.H.
• Eckerds Pharmacy LLC (Vistara Specialty Pharmacy)
• Michael Fisher, PT
• Kristi A Fitzmorris, MD
• Seth Edward Fricks, PHARMD
• Roopa Ganga, M.D.

• Long Term Care Pharmacy in Kenneth City, FL
• Providers in Kenneth City, FL by specialty
• Long Term Care Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.