Organization Active NPI

Medcity Pharmacy

  • Community/Retail Pharmacy
  • Yulee, FL
National Provider Identifier
1992047260
Registry record updated Mar 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PH26731 Issued in FL
Legal business name
MEDCITY PHARMACY
Practice address
463688 Sr 200
Suite #6
Yulee, FL 32097
Phone
(904) 432-3810
Fax
(904) 432-3811
NPI assigned
Mar 25, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2013

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

Authorized official

Name
Sumanth Edara
Title
Co-Owner
Phone
(904) 252-1568

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PH26731 FL Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

463688 Sr 200
Suite #6
Yulee, FL 32097

Mailing address

11988 Marldon LN
Jacksonville, FL 32258-9459
Phone (904) 252-1568

Other identifiers 1

IdentifierTypeStateIssuer
5713816OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • MEDCITY PHARMACY Doing business as

National Provider Directory

National Provider Directory

Locations

463688 State Road 200
Ste 6
Yulee, FL 32097
Phone (904) 432-3810

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1364169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364169600000",
    "number": "1992047260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11988 MARLDON LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322589459",
            "telephone_number": "904-252-1568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "463688 SR 200",
            "address_2": "SUITE #6",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "32097",
            "telephone_number": "904-432-3810",
            "fax_number": "904-432-3811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDCITY PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-25",
        "last_updated": "2013-03-25",
        "status": "A",
        "authorized_official_last_name": "EDARA",
        "authorized_official_first_name": "SUMANTH",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "904-252-1568"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH26731",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5713816",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDCITY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yulee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2013; 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.