Provider Demographics
NPI:1053646265
Name:SAN DIEGO D & M PHARMACIES INC
Entity type:Organization
Organization Name:SAN DIEGO D & M PHARMACIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:DIPHARM
Authorized Official - Phone:619-223-7171
Mailing Address - Street 1:955 CATALINA BLVD
Mailing Address - Street 2:#102A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2881
Mailing Address - Country:US
Mailing Address - Phone:619-630-2710
Mailing Address - Fax:619-630-2715
Practice Address - Street 1:955 CATALINA BLVD
Practice Address - Street 2:#102A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2881
Practice Address - Country:US
Practice Address - Phone:619-630-2710
Practice Address - Fax:619-630-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY500323336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053646265Medicaid
2122436OtherPK