Organization
BREVARD PHARMACY LLC
Active
Other names
Port St John Discount Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RAJESH PATEL (OWNER)
(407) 488-6851
Entity
Organization
Contact information
Practice address
6250 N US HIGHWAY 1, COCOA, FL 32927-4926
(321) 305-6975
(321) 305-6978
Mailing address
6250 N US HIGHWAY 1, COCOA, FL 32927-4926
(321) 305-6975
(321) 305-6978
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH30509
FL
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003226300
—
FL
01
—
2168151
PK
—
Enumeration date
03/13/2017
Last updated
03/13/2017
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