Healthcare Provider Details

I. General information

NPI: 1982900981
Provider Name (Legal Business Name): COREXA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 EAGLES LANDING DR.
LAKELAND FL
33810
US

IV. Provider business mailing address

354 EAGLES LANDING DR
LAKELAND FL
33810-2999
US

V. Phone/Fax

Practice location:
  • Phone: 727-896-0001
  • Fax: 727-896-0002
Mailing address:
  • Phone: 727-896-0001
  • Fax: 727-896-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25226
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NIKUL R PANCHAL
Title or Position: PIC/SVP OF PHARMACY
Credential:
Phone: 813-482-7700