MEDICARE: CMSS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1518787027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CMSS INC

Provider Business Mailing Address
First Line	:	PO BOX 3755
Second Line	:	340 OXFORD ST
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-3101
Country	:	US
Telephone Number	:	619-272-9866
Fax Number	:	619-489-5747

Provider Business Practice Location Address
First Line	:	1085 3RD AVE STE A
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-2008
Country	:	US
Telephone Number	:	619-272-9866
Fax Number	:	619-489-5747

Authorized Official
Title or Position	:	PRESIDENT
Name	:	COBY JACOB SHIMONOV
Credential	:
Telephone Number	:	619-272-9866

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	02/04/2026

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