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General NPI Number Information
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NPI Number | 1841694510
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Entity Type | Organization
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Legal Business Name | JUPITER COMPOUNDING LLC
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 155 TONEY PENNA DR STE 1B
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City | JUPITER
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State | FL
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Zip | 33458-5746
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Country | US
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Telephone | 561-203-8589
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Fax | 561-203-5153
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Provider Business Mailing Address
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Address Line | 155 TONEY PENNA DR SUITE 1B
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City | JUPITER
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State | FL
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Zip | 33458-5746
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Country | US
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Telephone | 561-203-8589
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Fax | 561-406-6816
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Authorized Official
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Title or Position | OWNER/PRESIDENT/AO
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Name | RAJ DATA
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Credential |
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Telephone | 561-203-8589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PH28425
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License Number State | FL
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