Provider Demographics
NPI:1669728176
Name:PRAMUKH KRUPA RX LLC
Entity type:Organization
Organization Name:PRAMUKH KRUPA RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DEPARTMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANANKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-667-6100
Mailing Address - Street 1:27432 CASHFORD CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6916
Mailing Address - Country:US
Mailing Address - Phone:813-667-6100
Mailing Address - Fax:813-667-6200
Practice Address - Street 1:27432 CASHFORD CIR STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6916
Practice Address - Country:US
Practice Address - Phone:813-667-6100
Practice Address - Fax:813-667-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH262703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5711292OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL006306100Medicaid