Healthcare Provider Details

I. General information

NPI: 1730226754
Provider Name (Legal Business Name): 4 M PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41120 WASHINGTON ST STE 100
BERMUDA DUNES CA
92203-9215
US

IV. Provider business mailing address

41120 WASHINGTON ST STE 100
BERMUDA DUNES CA
92203-9215
US

V. Phone/Fax

Practice location:
  • Phone: 760-772-7300
  • Fax: 760-772-7303
Mailing address:
  • Phone: 760-772-7300
  • Fax: 760-772-7303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY48653
License Number StateCA

VIII. Authorized Official

Name: MANISHA BODI
Title or Position: MANG TECH
Credential:
Phone: 760-772-7300