Provider Demographics
NPI:1598916850
Name:JDM ENTERPRISES OF VERO BEACH,LLC
Entity Type:Organization
Organization Name:JDM ENTERPRISES OF VERO BEACH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:772-567-5297
Mailing Address - Street 1:1635 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0435
Mailing Address - Country:US
Mailing Address - Phone:772-567-5297
Mailing Address - Fax:772-567-2134
Practice Address - Street 1:1635 14TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0435
Practice Address - Country:US
Practice Address - Phone:772-562-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6300150001Medicare NSC