Provider Demographics
NPI:1922635424
Name:KAILASHRX LLC
Entity Type:Organization
Organization Name:KAILASHRX LLC
Other - Org Name:COMMUNITY PHARMACY OF DELTONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAYESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MPHARM, RPH
Authorized Official - Phone:386-259-5435
Mailing Address - Street 1:1240 PROVIDENCE BLVD
Mailing Address - Street 2:UNIT 1 & 2
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7352
Mailing Address - Country:US
Mailing Address - Phone:386-259-5435
Mailing Address - Fax:386-259-9582
Practice Address - Street 1:1240 PROVIDENCE BLVD
Practice Address - Street 2:UNIT 1 & 2
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7352
Practice Address - Country:US
Practice Address - Phone:386-259-5435
Practice Address - Fax:386-259-9582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112450100Medicaid