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General NPI Number Information
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NPI Number | 1437517299
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Entity Type | Organization
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Legal Business Name | PALM DESERT PHARMACY INC
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 73261 HIGHWAY 111 SUITE 101
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City | PALM DESERT
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State | CA
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Zip | 92260-3928
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Country | US
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Telephone | 760-636-5587
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Fax | 760-636-5591
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Provider Business Mailing Address
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Address Line | 73261 HIGHWAY 111 SUITE 101
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City | PALM DESERT
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State | CA
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Zip | 92260-3928
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Country | US
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Telephone | 760-636-5587
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Fax | 760-636-5591
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Authorized Official
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Title or Position | PRESIDENT/ PHARMACIST IN CHARGE
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Name | MR. RAMIN MOLAI
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Credential |
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Telephone | 760-636-5587
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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 | PHY54328
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License Number State | CA
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