Organization
MARK E WANDEL
Active
Other names
BIG BEAR VALLEY MEDICAL ARTS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WANDEL (OWNER)
(909) 866-5881
Entity
Organization
Contact information
Practice address
42002 FOX FARM RD, SUITE 103, BIG BEAR LAKE, CA 92315
(909) 866-5881
(909) 866-8510
Mailing address
PO BOX 1549, BIG BEAR LAKE, CA 92315-1549
(909) 866-5881
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY44374
CA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0557073
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA443740
—
CA
Enumeration date
10/23/2006
Last updated
09/21/2009
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