Organization
PHARMACY MART INC
Active
Other names
The Medicine Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
RACHELLE DAVIS (PHARMACIST/OWNER)
(760) 868-2800
Entity
Organization
Contact information
Practice address
4050 PHELAN RD STE 8, PHELAN, CA 92371-4454
(760) 868-2800
(760) 868-5252
Mailing address
4050 PHELAN RD, STE 8, PHELAN, CA 92371-4454
(760) 868-2800
(760) 868-5852
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY54604
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2157699
PK
—
Enumeration date
01/20/2016
Last updated
11/08/2024
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