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General NPI Number Information
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NPI Number | 1467752691
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Entity Type | Organization
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Legal Business Name | BREVARD PHARMACY LLC
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 6250 N US HIGHWAY 1
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City | COCOA
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State | FL
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Zip | 32927-4926
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Country | US
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Telephone | 321-305-6975
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Fax | 321-305-6978
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Provider Business Mailing Address
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Address Line | 6250 N US HIGHWAY 1
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City | COCOA
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State | FL
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Zip | 32927-4926
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Country | US
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Telephone | 321-305-6975
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Fax | 321-305-6978
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Authorized Official
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Title or Position | OWNER
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Name | CHANDRIKABEN PATEL
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Credential | RPH
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Telephone | 407-488-6851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH30509
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License Number State | FL
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