Organization
I M B ENTERPRISES
Active
Other names
INDIO MEDICAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE KAN (PHARACIST OWNER)
(760) 347-0659
Entity
Organization
Contact information
Practice address
81893 DR CARREON BLVD, STE 7, INDIO, CA 92201-0604
(760) 347-0659
(760) 347-5972
Mailing address
81893 DR CARREON BLVD, STE 7, INDIO, CA 92201-0604
(760) 347-0659
(760) 347-5972
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY21267
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000923
PK
—
05
—
PHA212670
—
CA
Enumeration date
05/28/2006
Last updated
12/08/2016
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