MEDICARE: CDM PHARMACY

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1255482709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDM PHARMACY

Provider Business Mailing Address
First Line	:	716 E BALBOA BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92661-1306
Country	:	US
Telephone Number	:	949-673-5370
Fax Number	:	949-673-3600

Provider Business Practice Location Address
First Line	:	716 E BALBOA BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92661-1306
Country	:	US
Telephone Number	:	949-673-5370
Fax Number	:	949-673-3600

Authorized Official
Title or Position	:	CEO
Name	:	MR. JEFFREY BRIAN FORD
Credential	:
Telephone Number	:	949-673-5370

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	03/31/2020

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Directions to “CDM PHARMACY ” Practice Location

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