Healthcare Provider Details

I. General information

NPI: 1982052361
Provider Name (Legal Business Name): JJDRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 PROVIDENCE BLVD STE 2
DELTONA FL
32725-7352
US

IV. Provider business mailing address

1240 PROVIDENCE BLVD STE 2
DELTONA FL
32725-7352
US

V. Phone/Fax

Practice location:
  • Phone: 386-968-1066
  • Fax: 386-259-5018
Mailing address:
  • Phone: 386-968-1066
  • Fax: 386-259-5018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH30141
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARTIN SZKODZINSKI
Title or Position: PRESIDENT
Credential:
Phone: 813-326-0877