Healthcare Provider Details

I. General information

NPI: 1699853564
Provider Name (Legal Business Name): JET-IPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CONOWINGO RD
BEL AIR MD
21014-1812
US

IV. Provider business mailing address

1510 CONOWINGO RD
BEL AIR MD
21014-1812
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-0990
  • Fax: 410-836-8429
Mailing address:
  • Phone: 410-838-0990
  • Fax: 410-836-8429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPW0058
License Number StateMD

VIII. Authorized Official

Name: MR. JAMES PETER TRISTANI
Title or Position: PRESIDENT
Credential: BS,PD
Phone: 410-838-0990