=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376449959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARMEDIX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2026
-----------------------------------------------------
Last Update Date | 10/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2755 VIA CAPRI UNIT 1229
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33764-5904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-846-0378
-----------------------------------------------------
Fax | 870-846-0378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1913 S MINTLE ST TRLR 42
-----------------------------------------------------
City | AIRWAY HEIGHTS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99001-5262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-846-0378
-----------------------------------------------------
Fax | 870-846-0378
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MGR
-----------------------------------------------------
Name | JOHNNIE KEMP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 870-846-0378
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------