MEDICARE: EMJ PHARMACY CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY56131	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2177385	OTHER		PK

General Provider Information

NPI Number	:	1144315896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMJ PHARMACY CORPORATION

Provider Business Mailing Address
First Line	:	665 CAMINO DE LOS MARES STE 101
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-2840
Country	:	US
Telephone Number	:	949-496-0123
Fax Number	:	949-496-0489

Provider Business Practice Location Address
First Line	:	665 CAMINO DE LOS MARES STE 101
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-2840
Country	:	US
Telephone Number	:	949-496-0123
Fax Number	:	949-496-0489

Authorized Official
Title or Position	:	CEO
Name	:	EUGENE MEDLEY
Credential	:
Telephone Number	:	949-496-0123

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	06/06/2018

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Directions to “EMJ PHARMACY CORPORATION ” Practice Location

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