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General NPI Number Information
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NPI Number | 1285185488
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Entity Type | Organization
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Legal Business Name | D J A M INC
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Dates
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Enumeration Date | 10/23/2016
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Last Update Date | 03/17/2017
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Provider Practice Location Address
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Address Line | 3936 PHELAN RD STE A1
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City | PHELAN
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State | CA
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Zip | 92371-4142
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Country | US
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Telephone | 760-706-0130
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Fax | 760-706-0131
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Provider Business Mailing Address
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Address Line | 9778 SVL BOX
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City | VICTORVILLE
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State | CA
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Zip | 92395-5142
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Country | US
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Telephone | 760-706-0130
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Fax | 760-706-0131
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Authorized Official
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Title or Position | CEO
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Name | JANET ATTIA
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Credential |
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Telephone | 760-980-0920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 54488
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License Number State | CA
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