MEDICARE: JDM ENTERPRISES OF VERO BEACH,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy		FL

General Provider Information

NPI Number	:	1598916850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JDM ENTERPRISES OF VERO BEACH,LLC

Provider Business Mailing Address
First Line	:	1635 14TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-0435
Country	:	US
Telephone Number	:	772-567-5297
Fax Number	:	772-567-2134

Provider Business Practice Location Address
First Line	:	1635 14TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-0435
Country	:	US
Telephone Number	:	772-562-3660
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. DOUGLAS TODD MILLER
Credential	:	RPH
Telephone Number	:	772-567-5297

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	11/01/2011

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