Provider Demographics
NPI:1558349233
Name:MY PHARMACY OF HOMESTEAD INC
Entity type:Organization
Organization Name:MY PHARMACY OF HOMESTEAD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MURALI
Authorized Official - Middle Name:KRISHNA
Authorized Official - Last Name:KOTHURI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-247-6949
Mailing Address - Street 1:806 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4407
Mailing Address - Country:US
Mailing Address - Phone:305-247-6949
Mailing Address - Fax:305-246-0742
Practice Address - Street 1:806 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4407
Practice Address - Country:US
Practice Address - Phone:305-247-6949
Practice Address - Fax:305-246-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 332BP3500X, 332BX2000X, 335E00000X
FLPH10256333600000X, 3336C0003X, 3336C0004X, 3336H0001X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018377800Medicaid
FLPH10256OtherPHARMACY
FL1011814OtherNABP
FL1011814OtherNABP
FLBM1329538OtherDEA
FLBM1329538OtherDEA