=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558390732
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANMAT CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 N MOLLISON AVE # 101
-----------------------------------------------------
City | EL CAJON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92021-6159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-441-8811
-----------------------------------------------------
Fax | 619-441-8073
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 N MOLLISON AVE # 101
-----------------------------------------------------
City | EL CAJON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92021-6159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-441-8811
-----------------------------------------------------
Fax | 619-441-8073
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. BASSAM HANNA MASSAAD
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 619-441-8811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY47248
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------