=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295289676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHCHASE COMMUNITY PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2016
-----------------------------------------------------
Last Update Date | 03/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12981 S ORANGE BLOSSOM TRL
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32837-6592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-204-4090
-----------------------------------------------------
Fax | 407-204-4094
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13726 BUDWORTH CIR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32832-6114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-204-4090
-----------------------------------------------------
Fax | 407-204-4094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SAROJ KODE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-204-4090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH30301
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------