Public Square Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Jacksonville, FL
NPI 1992273023 · NPPES record last updated Aug 21, 2025
Key facts
- NPI
- 1992273023
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- PUBLIC SQUARE PHARMACY LLC
- Practice address
- 2736 University Blvd W Ste 2
Jacksonville, FL 32217-2170 - Phone
- (941) 204-1610
- Fax
- (904) 376-7718
- NPI assigned
- Nov 7, 2018
- Organization subpart
- No
Authorized official
- Name
- Diego Gomez, PHARM. D.
- Title
- Owner Pharmacy Manager
- Phone
- (941) 204-1610
Corporate family (same tax ID) 1
Practitioners 2
-
Diego Gomez, PHARMD
-
Duy Nguyen, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190214000576 | FL | Part B Supplier - Pharmacy | 8527306745 | Practice locations: Jacksonville, FL |
| O20200130000511 | FL | DME Supplier - Pharmacy | 8527306745 | Practice locations: Jacksonville, FL |
| O20201026002935 | FL | Part B Supplier - Independent Clinical Laboratory | 8527306745 | Practice locations: Jacksonville, FL |
National Provider Directory
- Tax ID family
- Public Square Pharmacy
Locations
2736 University Blvd W
Ste 2
Jacksonville, FL 32217
Phone (904) 531-4556
11757 Beach Blvd
Jacksonville, FL 32246
Phone (904) 531-4556
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
2736 University Blvd W Ste 2
Jacksonville, FL 32217-2170
Mailing address
2736 University Blvd W
Jacksonville, FL 32217-2179
Phone (941) 204-1610
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101862900 | Medicaid | FL |
Other names
- Public Square Pharmacy
Other providers in Jacksonville, FL
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- Dinesh Pubbi
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All providers in Jacksonville, 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 Aug 21, 2025. 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.