Provider Demographics
NPI:1669252813
Name:PHARMACY MART INC
Entity type:Organization
Organization Name:PHARMACY MART INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-987-6796
Mailing Address - Street 1:4050 PHELAN RD STE 8
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-4454
Mailing Address - Country:US
Mailing Address - Phone:760-868-2800
Mailing Address - Fax:760-868-5252
Practice Address - Street 1:4050 PHELAN RD STE 8
Practice Address - Street 2:
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-4454
Practice Address - Country:US
Practice Address - Phone:760-868-2800
Practice Address - Fax:760-868-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy