Provider Demographics
NPI:1265828594
Name:ENDMETRX LLC
Entity Type:Organization
Organization Name:ENDMETRX LLC
Other - Org Name:MEDPLUS RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:407-930-8908
Mailing Address - Street 1:2136 WHISPER LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6761
Mailing Address - Country:US
Mailing Address - Phone:407-930-8908
Mailing Address - Fax:407-930-8967
Practice Address - Street 1:2136 WHISPER LAKES BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6761
Practice Address - Country:US
Practice Address - Phone:407-930-8908
Practice Address - Fax:407-930-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME014969900Medicaid