Eckerds Pharmacy LLC – Community/Retail Pharmacy

Key facts

NPI: 1922577832
Entity type: Organization (NPI type 2)
Primary specialty: Community/Retail Pharmacy 3336C0003X
Legal business name: ECKERDS PHARMACY LLC
Practice address: 4404 66TH St N
Kenneth City, FL 33709-4922
Phone: (727) 513-1107
Fax: (727) 513-1109
NPI assigned: Nov 20, 2018
Organization subpart: No

Authorized official

Name: Bhaveshkumar Patel
Title: Pic
Phone: (813) 900-4995

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Eckerds Pharmacy LLC Long Term Care Pharmacy · Kenneth City, FL · NPI 1578198560

NPPES parent name

Practitioners 1

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

Bhaveshkumar Patel Pharmacist · Riverview, FL · NPI 1508469040

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in FL

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20200423003468	FL	Part B Supplier - Mass Immunization (Roster Biller Only)	6800137928	Practice locations: Kenneth City, FL

National Provider Directory

Networks

Freedom Health HMO Network
Plans: 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 Network
Plans: 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)

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Community/Retail Pharmacy	3336C0003X			Yes
Specialty Pharmacy	3336S0011X

Addresses

Primary practice location

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

Mailing address

4404 66TH St N
Kenneth City, FL 33709-4922
Phone (727) 513-1107

Other identifiers

Identifier	Type	State	Issuer
PH31757	Other	FL	LICENSE
101899100	Medicaid	FL

Other names

VISTARA SPECIALTY PHARMACY Doing business as

Other providers in Kenneth City, FL

All providers in Kenneth City, FL · Community/Retail Pharmacy in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider 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.