Provider Demographics
NPI:1013382662
Name:NIA RX SERVICES LLC
Entity Type:Organization
Organization Name:NIA RX SERVICES LLC
Other - Org Name:BRANDON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FALGUN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-420-5436
Mailing Address - Street 1:500 VONDERBURG DR STE 113W
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5969
Mailing Address - Country:US
Mailing Address - Phone:813-684-4444
Mailing Address - Fax:813-684-3444
Practice Address - Street 1:500 VONDERBURG DR STE 113W
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5969
Practice Address - Country:US
Practice Address - Phone:813-684-4444
Practice Address - Fax:813-684-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH295893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2156208OtherPK
FL016753800Medicaid