Organization
MDM PHARMACY SERVICES 2
Active
Other names
New Pharmacy 2
Organization subpart
No
Provider details
NPI number
Authorized official
MAHER MICHAIL RPH (OWNER / PIC/ AO)
(760) 851-8120
Entity
Organization
Contact information
Practice address
72724 29 PALMS HWY STE 104, TWENTYNINE PALMS, CA 92277-2459
(760) 367-2000
(760) 367-2001
Mailing address
57725 29 PALMS HWY, STE 209, YUCCA VALLEY, CA 92284-3044
(760) 228-1600
(760) 228-0400
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY52555
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2152780
PK
—
Enumeration date
06/20/2015
Last updated
04/17/2017
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