Provider Demographics
NPI:1417041823
Name:JPRX INC
Entity Type:Organization
Organization Name:JPRX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:314-842-0910
Mailing Address - Street 1:11330 GRAVOIS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAPPINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11330 GRAVOIS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAPPINGTON
Practice Address - State:MO
Practice Address - Zip Code:63126-3608
Practice Address - Country:US
Practice Address - Phone:314-842-0910
Practice Address - Fax:314-842-7982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO0061143336C0003X
MO00611443336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2627404OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MO602357105Medicaid
1307480001Medicare NSC