Organization
4 M PHARMACY INC
Active
Organization
4 M PHARMACY INC
Active
Other names
JFK MEDICAL PLAZA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MANISHA BODI (MANG TECH)
(760) 772-7300
Entity
Organization
Contact information
Practice address
41120 WASHINGTON ST, STE 100, BERMUDA DUNES, CA 92203-9215
(760) 772-7300
(760) 772-7303
Mailing address
41120 WASHINGTON ST, STE 100, BERMUDA DUNES, CA 92203-9215
(760) 772-7300
(760) 772-7303
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY48653
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0544052
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHY416810
—
CA
Enumeration date
01/31/2007
Last updated
10/22/2010
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