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General NPI Number Information
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NPI Number | 1659235224
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Entity Type | Organization
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Legal Business Name | JUPITER WELLNESS CO LLC
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 18218 JAMES COUZENS FWY
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City | DETROIT
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State | MI
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Zip | 48235-2501
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Country | US
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Telephone | 313-699-5301
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Fax |
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Provider Business Mailing Address
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Address Line | 41470 E ARCHWOOD DR APT 134
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City | VAN BUREN TOWNSHIP
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State | MI
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Zip | 48111-4525
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Country | US
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Telephone | 313-699-5301
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Fax |
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Authorized Official
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Title or Position | LMT
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Name | MALLARY JACKSON
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Credential | LMT
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Telephone | 313-699-5301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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