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General NPI Number Information
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NPI Number | 1730226754
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Entity Type | Organization
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Legal Business Name | 4 M PHARMACY INC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 41120 WASHINGTON ST STE 100
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City | BERMUDA DUNES
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State | CA
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Zip | 92203-9215
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Country | US
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Telephone | 760-772-7300
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Fax | 760-772-7303
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Provider Business Mailing Address
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Address Line | 41120 WASHINGTON ST STE 100
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City | BERMUDA DUNES
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State | CA
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Zip | 92203-9215
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Country | US
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Telephone | 760-772-7300
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Fax | 760-772-7303
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Authorized Official
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Title or Position | MANG TECH
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Name | MANISHA BODI
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Credential |
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Telephone | 760-772-7300
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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 | PHY48653
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License Number State | CA
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