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General NPI Number Information
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NPI Number | 1255482709
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Entity Type | Organization
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Legal Business Name | CDM PHARMACY
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 716 E BALBOA BLVD
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City | NEWPORT BEACH
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State | CA
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Zip | 92661-1306
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Country | US
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Telephone | 949-673-5370
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Fax | 949-673-3600
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Provider Business Mailing Address
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Address Line | 716 E BALBOA BLVD
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City | NEWPORT BEACH
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State | CA
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Zip | 92661-1306
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Country | US
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Telephone | 949-673-5370
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Fax | 949-673-3600
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Authorized Official
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Title or Position | CEO
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Name | MR. JEFFREY BRIAN FORD
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Credential |
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Telephone | 949-673-5370
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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 |
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License Number State |
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