Provider Demographics
NPI:1487965018
Name:PHARMAKON LLC
Entity type:Organization
Organization Name:PHARMAKON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.M.
Authorized Official - Prefix:MR
Authorized Official - First Name:DARSHAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-571-2754
Mailing Address - Street 1:2386 DUNN AVE
Mailing Address - Street 2:SUITE #117
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4602
Mailing Address - Country:US
Mailing Address - Phone:904-696-8882
Mailing Address - Fax:904-696-9982
Practice Address - Street 1:2386 DUNN AVE
Practice Address - Street 2:SUITE #117
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4602
Practice Address - Country:US
Practice Address - Phone:904-696-8882
Practice Address - Fax:904-696-9982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 247213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002748000Medicaid
FL002748001OtherMEDICAID - DME
FLHN481AOtherMEDICARE NSC - IMMUNIZAITON
FL002748001OtherMEDICAID - DME