Provider Demographics
NPI:1467652024
Name:GOOD RX V LLC
Entity Type:Organization
Organization Name:GOOD RX V LLC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:727-375-2502
Mailing Address - Street 1:10720 STATE ROAD 54
Mailing Address - Street 2:STE 103
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-2217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10720 STATE ROAD 54
Practice Address - Street 2:STE 103
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-2217
Practice Address - Country:US
Practice Address - Phone:727-375-2502
Practice Address - Fax:727-375-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
FLPH228643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1027843OtherOTHER ID NUMBER
FL032218100Medicaid
FL032218100Medicaid
FL032218100Medicaid
FL5994910001Medicare NSC