Healthcare Provider Details

I. General information

NPI: 1124025770
Provider Name (Legal Business Name): JD RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 TERRY RD
SMITHTOWN NY
11787-5510
US

IV. Provider business mailing address

347 TERRY RD
SMITHTOWN NY
11787-5510
US

V. Phone/Fax

Practice location:
  • Phone: 631-361-4100
  • Fax: 631-361-4178
Mailing address:
  • Phone: 631-361-4100
  • Fax: 631-361-4178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4890760001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number26072
License Number StateNY

VIII. Authorized Official

Name: DAVID BLATT
Title or Position: SEC,TSR,SUPERVISING RPH
Credential: R.PH.
Phone: 631-361-4100