1285667584 NPI number — PDI PHARMACY SERVICES OF JUPITER, INC.

Table of content: (NPI 1285667584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285667584 NPI number — PDI PHARMACY SERVICES OF JUPITER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PDI PHARMACY SERVICES OF JUPITER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285667584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 JUPITER PARK DR.
Provider Second Line Business Mailing Address:
SUITE #128
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-8971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-745-8338
Provider Business Mailing Address Fax Number:
561-745-8386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 JUPITER PARK DR.
Provider Second Line Business Practice Location Address:
SUITE #128
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-8971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-745-8338
Provider Business Practice Location Address Fax Number:
561-745-8386
Provider Enumeration Date:
07/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRABER
Authorized Official First Name:
NORBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-745-8338

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)