MEDICARE: MERRITT ISLAND PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PH26203	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2135755	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508120395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERRITT ISLAND PHARMACY

Provider Business Mailing Address
First Line	:	35 N COURTENAY PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3476
Country	:	US
Telephone Number	:	321-454-0911
Fax Number	:	321-459-2479

Provider Business Practice Location Address
First Line	:	35 N COURTENAY PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3476
Country	:	US
Telephone Number	:	321-454-0911
Fax Number	:	321-459-2479

Authorized Official
Title or Position	:	PHARMACY MANAGER, PIC
Name	:	BHAVIN DHADUK
Credential	:	RPH
Telephone Number	:	201-916-7125

Provider Enumeration Date	:	06/27/2012
Last Update Date	:	09/19/2025

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