Organization
BREVARD PHARMACY LLC
Active
Organization
BREVARD PHARMACY LLC
Active
Other names
Port St John Discount Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHANDRIKABEN PATEL RPH (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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003226300
—
FL
05
—
003226301
—
FL
01
—
2127271
PK
—
Enumeration date
10/21/2010
Last updated
03/06/2017
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