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General NPI Number Information
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NPI Number | 1053751024
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Entity Type | Organization
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Legal Business Name | EMMANUEL PHARMACY CORP.
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Dates
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Enumeration Date | 07/04/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 77760 COUNTRY CLUB DR SUITE I
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City | PALM DESERT
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State | CA
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Zip | 92211-6247
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Country | US
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Telephone | 760-360-1080
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Fax | 760-360-1085
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Provider Business Mailing Address
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Address Line | 77760 COUNTRY CLUB DR SUITE I
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City | PALM DESERT
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State | CA
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Zip | 92211-6247
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Country | US
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Telephone | 760-360-1080
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WALID IBRAHIM
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Credential |
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Telephone | 760-835-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 51507
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License Number State | CA
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