NPIMap

Organization Active NPI

Goldenrod Pharmacy LLC

  • Community/Retail Pharmacy
  • Orlando, FL
National Provider Identifier
1902220197
Registry record updated Jul 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PH27437 Issued in FL
Legal business name
GOLDENROD PHARMACY LLC
Practice address
2223 S Goldenrod Rd
Orlando, FL 32822-4676
Phone
(407) 730-3866
Fax
(407) 730-3347
NPI assigned
Feb 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2016

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

Authorized official

Name
Anupama Boddapati
Title
President
Phone
(405) 474-9393

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PH27437 FL Primary

Addresses

Primary practice location

2223 S Goldenrod Rd
Orlando, FL 32822-4676

Mailing address

2223 S Goldenrod Rd
Orlando, FL 32822-4676
Phone (407) 730-3866

Other identifiers 2

IdentifierTypeStateIssuer
011063200MedicaidFL
2144154OtherPK

Other names 1

  • Goldenrod Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210122001878 FL Part B Supplier - Mass Immunization (Roster Biller Only) 6204240864 1 other NPI on this enrollment
Practice locations: Kissimmee, FL; Orlando, FL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
BVL Pharmacy3 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.

Networks

  • 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)
  • 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)…

NPI Registry JSON

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

{
    "created_epoch": "1391990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468972800000",
    "number": "1902220197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2223 S GOLDENROD RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328224676",
            "telephone_number": "407-730-3866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 S GOLDENROD RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328224676",
            "telephone_number": "407-730-3866",
            "fax_number": "407-730-3347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDENROD PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-10",
        "last_updated": "2016-07-20",
        "status": "A",
        "authorized_official_last_name": "BODDAPATI",
        "authorized_official_first_name": "ANUPAMA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-474-9393"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH27437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011063200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2144154",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goldenrod Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; 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.