Provider Demographics
NPI:1285185488
Name:D J A M INC
Entity Type:Organization
Organization Name:D J A M INC
Other - Org Name:PHELAN FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-980-0920
Mailing Address - Street 1:9778 SVL BOX
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5142
Mailing Address - Country:US
Mailing Address - Phone:760-706-0130
Mailing Address - Fax:760-706-0131
Practice Address - Street 1:3936 PHELAN RD STE A1
Practice Address - Street 2:
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-4142
Practice Address - Country:US
Practice Address - Phone:760-706-0130
Practice Address - Fax:760-706-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-23
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA544883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165868OtherPK