Provider Demographics
NPI:1982769303
Name:KME RX INC
Entity Type:Organization
Organization Name:KME RX INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JETENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETWARU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:561-432-0402
Mailing Address - Street 1:3491 S CONGRESS AVE
Mailing Address - Street 2:BAY 6
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3491 S CONGRESS AVE
Practice Address - Street 2:BAY 6
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3021
Practice Address - Country:US
Practice Address - Phone:561-432-0402
Practice Address - Fax:561-432-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH20069333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026869100Medicaid
FL026869101Medicaid
1004023OtherOTHER ID NUMBER-COMMERCIAL NUMBER
FLBK8801943OtherDEA #
FL026869100Medicaid
FLX8220Medicare PIN
FLX8220AMedicare PIN