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PICH KTM CORP NPI 1043626153


NPI Information

NPI: 1043626153
Provider Name: PICH KTM CORP

Doing Business As: MEDTOWN PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 10D2168917

Address:
11643 BEACH BLVD
UNIT A
JACKSONVILLE, FL
ZIP 32246
Phone: (904) 551-5870
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PICH KTM CORP is a community/retail pharmacy pharmacy in Jacksonville, FL. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. PICH KTM CORP NPI is 1043626153. The provider is registered as an organization entity type.
The provider Is Doing Business As Medtown Pharmacy.

The provider's business location address is:

11643 BEACH BLVD
UNIT A
JACKSONVILLE, FL
ZIP 32246
Phone: (904) 551-5870
Fax: (904) 619-6227

The provider's authorized official is Chen Oeur .
The authorized official title is Pharmacist/pharmacy Owner and has the following contact phone number (904) 551-5870.

The CLIA number assigned to this NPI record is 10D2168917 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/9/2014 and was last updated on 5/1/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
13336C0003XPharmacyCommunity/Retail PharmacyPH28291FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1013879700MEDICAIDFLORIDA
22147617OTHERPK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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