Provider Demographics
NPI:1982052361
Name:JJDRUG CO
Entity Type:Organization
Organization Name:JJDRUG CO
Other - Org Name:JJ'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SZKODZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-326-0877
Mailing Address - Street 1:1240 PROVIDENCE BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7352
Mailing Address - Country:US
Mailing Address - Phone:386-968-1066
Mailing Address - Fax:386-259-5018
Practice Address - Street 1:1240 PROVIDENCE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7352
Practice Address - Country:US
Practice Address - Phone:386-968-1066
Practice Address - Fax:386-259-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH30141333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162471OtherPK