MEDICARE: JRC COMPOUNDING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PH33135	OTHER	FL	PHARMACY PERMIT

General Provider Information

NPI Number	:	1295327633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JRC COMPOUNDING

Provider Business Mailing Address
First Line	:	18114 POWELL RD
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-8141
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18114 POWELL RD
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-8141
Country	:	US
Telephone Number	:	352-345-4849
Fax Number	:	352-345-8038

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. MICHAEL CLURMAN
Credential	:	PHARMD
Telephone Number	:	352-345-5303

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	02/08/2021

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Directions to “JRC COMPOUNDING ” Practice Location

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