=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518292903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JPPD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2009
-----------------------------------------------------
Last Update Date | 06/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 NE SPANISH RIVER BLVD SUITE#106
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-6100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-544-8997
-----------------------------------------------------
Fax | 561-544-8131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 NE SPANISH RIVER BLVD SUITE#106
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-6100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-544-8997
-----------------------------------------------------
Fax | 561-544-8131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JONAS KALKSTEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-716-7615
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH24266
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------