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General NPI Number Information
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NPI Number | 1992162077
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Entity Type | Organization
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Legal Business Name | PHARMACY MART INC
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 4050 PHELAN RD STE 8
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City | PHELAN
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State | CA
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Zip | 92371-4454
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Country | US
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Telephone | 760-868-2800
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Fax | 760-868-5252
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Provider Business Mailing Address
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Address Line | 4050 PHELAN RD STE 8
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City | PHELAN
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State | CA
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Zip | 92371-4454
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Country | US
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Telephone | 760-868-2800
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Fax | 760-868-5852
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | RACHELLE DAVIS
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Credential |
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Telephone | 760-868-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 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 #3
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY54604
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License Number State | CA
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