Healthcare Provider Details

I. General information

NPI: 1417041823
Provider Name (Legal Business Name): JPRX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11330 GRAVOIS RD SUITE 202
SAPPINGTON MO
63126-3608
US

IV. Provider business mailing address

11330 GRAVOIS RD SUITE 202
SAPPINGTON MO
63126-3608
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-0910
  • Fax: 314-842-7982
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number0061144
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number006114
License Number StateMO

VIII. Authorized Official

Name: ALEX VAYMAN
Title or Position: PRESIDENT
Credential: PHARM D
Phone: 314-842-0910