Provider Demographics
NPI:1356356901
Name:A CHEM RX LLC
Entity type:Organization
Organization Name:A CHEM RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEMPARATHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-592-1320
Mailing Address - Street 1:12116 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5514
Mailing Address - Country:US
Mailing Address - Phone:352-592-1320
Mailing Address - Fax:352-592-1321
Practice Address - Street 1:12116 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5514
Practice Address - Country:US
Practice Address - Phone:352-592-1320
Practice Address - Fax:352-592-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH246223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124531OtherPK
FL002127800Medicaid