Eckerds Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

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

Nov 20, 2018

Last updated

Jan 18, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bhaveshkumar PatelNPI 1508469040

Title

Pic

Phone

(813) 900-4995

Specialties & licenses 2

Addresses

Other names 1

• VISTARA SPECIALTY PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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 Máximo (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)

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

  dba Vistara Specialty Pharmacy

  • 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, 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": "1542672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1922577832",
    "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": "NO",
        "enumeration_date": "2018-11-20",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "BHAVESHKUMAR",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "813-900-4995"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VISTARA SPECIALTY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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.
• Susannah B Gariepy, AU.D.

• Community/Retail Pharmacy in Kenneth City, FL
• Providers in Kenneth City, 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 18, 2024; 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.