Provider Demographics
NPI:1285667584
Name:PDI PHARMACY SERVICES OF JUPITER, INC.
Entity Type:Organization
Organization Name:PDI PHARMACY SERVICES OF JUPITER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-745-8338
Mailing Address - Street 1:1001 JUPITER PARK DR.
Mailing Address - Street 2:SUITE #128
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8971
Mailing Address - Country:US
Mailing Address - Phone:561-745-8338
Mailing Address - Fax:561-745-8386
Practice Address - Street 1:1001 JUPITER PARK DR.
Practice Address - Street 2:SUITE #128
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8971
Practice Address - Country:US
Practice Address - Phone:561-745-8338
Practice Address - Fax:561-745-8386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Not Answered3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5718850001Medicare ID - Type Unspecified