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Organization
JUPITER COMPOUNDING LLC
Active
Organization
JUPITER COMPOUNDING LLC
Active
Other names
Jupiter Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RAJ DATA (OWNER/PRESIDENT/AO)
(561) 203-8589
Entity
Organization
Contact information
Practice address
155 TONEY PENNA DR STE 1B, JUPITER, FL 33458-5746
(561) 203-8589
(561) 203-5153
Mailing address
155 TONEY PENNA DR, SUITE 1B, JUPITER, FL 33458-5746
(561) 203-8589
(561) 406-6816
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PH28425
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148293
PK
—
Enumeration date
10/09/2014
Last updated
03/09/2017
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