PICH KTM CORP NPI 1043626153

NPI Details

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 following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

• Fee covid-19 vac 13 res (HCPCS:0124A)
• Coronavirus vaccine 13 (HCPCS:91312)
• Administration of influenza virus vaccine (HCPCS:G0008)
• Adm sarscv2 30mcg trs-sucr 1 (HCPCS:0051A)
• Sarscov2 vac 30 mcg trs-sucr (HCPCS:91305)
• Influenza vaccine, quadrivalent derived from cell cultures (HCPCS:90756)
• Severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 30 mcg/0.3ml dosage, diluent reconstituted, for intramuscular use (HCPCS:91300)
• Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 30 mcg/0.3ml dosage, diluent reconstituted; first dose (HCPCS:0001A)
• Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage (HCPCS:90694)

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:

Other Identifiers

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