1053646265 NPI number — SAN DIEGO D & M PHARMACIES INC

Table of content: (NPI 1053646265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053646265 NPI number — SAN DIEGO D & M PHARMACIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN DIEGO D & M PHARMACIES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053646265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
955 CATALINA BLVD
Provider Second Line Business Mailing Address:
#102A
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92106-2881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-630-2710
Provider Business Mailing Address Fax Number:
619-630-2715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
955 CATALINA BLVD
Provider Second Line Business Practice Location Address:
#102A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92106-2881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-630-2710
Provider Business Practice Location Address Fax Number:
619-630-2715
Provider Enumeration Date:
10/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SAAD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/PHARMACIST
Authorized Official Telephone Number:
619-223-7171

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY50032 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1053646265 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2122436 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com