Organization
PSJ PHARMACY LLC
Active
Other names
Port St John Discount Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RAJESH PATEL RPH (MANAGER)
(407) 488-6851
Entity
Organization
Contact information
Practice address
6801 N US HIGHWAY 1 STE 1, COCOA, FL 32927-5095
(321) 637-0911
(321) 639-0856
Mailing address
6801 N US HIGHWAY 1 STE 1, COCOA, FL 32927-5095
(321) 637-0911
(321) 639-0856
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH23958
FL
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001149900
—
FL
05
—
001149901
—
FL
01
—
2119675
PK
—
Enumeration date
04/08/2009
Last updated
03/30/2015
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