Provider Demographics
NPI:1104271873
Name:KD RX LLC
Entity type:Organization
Organization Name:KD RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, RPH, AO
Authorized Official - Prefix:
Authorized Official - First Name:FALGUN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-605-0055
Mailing Address - Street 1:4644 W GANDY BLVD
Mailing Address - Street 2:UNIT 4
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-3300
Mailing Address - Country:US
Mailing Address - Phone:813-605-0055
Mailing Address - Fax:813-605-0099
Practice Address - Street 1:4644 W GANDY BLVD
Practice Address - Street 2:UNIT 4
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3300
Practice Address - Country:US
Practice Address - Phone:813-605-0055
Practice Address - Fax:813-605-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH300973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018841500Medicaid
2159847OtherPK