Provider Demographics
NPI:1255332615
Name:C.M.I. DRUG CORPORATION
Entity Type:Organization
Organization Name:C.M.I. DRUG CORPORATION
Other - Org Name:CAL-MED PHARMACY WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOUDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-248-8900
Mailing Address - Street 1:2251 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1415
Mailing Address - Country:US
Mailing Address - Phone:818-248-8900
Mailing Address - Fax:818-248-8903
Practice Address - Street 1:2251 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-1415
Practice Address - Country:US
Practice Address - Phone:818-248-8900
Practice Address - Fax:818-248-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY33068333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA134560Medicaid
CAPHY33068OtherPHARMACY LICENSE
CAPHY33068OtherPHARMACY LICENSE
CA0529700001Medicare ID - Type Unspecified