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General NPI Number Information
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NPI Number | 1689778631
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Entity Type | Organization
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Legal Business Name | DOMEL INC.
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 12350 CALIFORNIA ST
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City | YUCAIPA
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State | CA
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Zip | 92399-4404
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Country | US
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Telephone | 909-797-9191
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Fax | 909-797-4784
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Provider Business Mailing Address
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Address Line | PO BOX 1497
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City | HEMET
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State | CA
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Zip | 92546-1497
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Country | US
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Telephone | 909-797-9191
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MELVIN EIREW
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Credential |
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Telephone | 951-658-7247
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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 | PHY18305
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License Number State | CA
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