Pelican Village Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PELICAN VILLAGE PHARMACY, LLC

Practice address

24830 S Tamiami TRL Ste 1800
Bonita Springs, FL 34134-7017

Phone

(239) 319-0744

Fax

(239) 319-0856

NPI assigned

Dec 26, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Suresh Chaudhari, RPHNPI 1790009819

Title

Owner

Phone

(239) 560-4354

Specialties & licenses 1

Addresses

Other names 1

• PELICAN PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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 Maximo (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 2

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

• Suresh Chaudhari

  • Pharmacist
  • Naples, FL
  • NPI 1790009819
  NPD Authorized official
• Krunal Bhagat

  • Pharmacist
  • Fort Myers, FL
  • NPI 1841893567
  NPD

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

{
    "created_epoch": "1608940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1841887767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24830 S TAMIAMI TRL STE 1800",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341347017",
            "telephone_number": "239-319-0744",
            "fax_number": "239-319-0856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24830 S TAMIAMI TRL STE 1800",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341347017",
            "telephone_number": "239-319-0744",
            "fax_number": "239-319-0856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELICAN VILLAGE PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-26",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A",
        "authorized_official_last_name": "CHAUDHARI",
        "authorized_official_first_name": "SURESH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-560-4354",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PELICAN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PELICAN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Bonita Springs, FL
• Providers in Bonita Springs, 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 Feb 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.