Healthcare Provider Details

I. General information

NPI: 1336816669
Provider Name (Legal Business Name): DM CLINICAL COLLABORATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6108 SAN FERNANDO RD
GLENDALE CA
91201-2240
US

IV. Provider business mailing address

PO BOX 2578
SECAUCUS NJ
07096-2578
US

V. Phone/Fax

Practice location:
  • Phone: 877-828-3940
  • Fax: 877-828-3941
Mailing address:
  • Phone: 877-828-3940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DHARA PATEL
Title or Position: PRESIDENT
Credential:
Phone: 877-828-3940