Provider Demographics
NPI:1518072545
Name:SAN DIEGO D & M PHARMACIES INC
Entity Type:Organization
Organization Name:SAN DIEGO D & M PHARMACIES INC
Other - Org Name:POINT LOMA SHELTER ISLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:DIP PHARM
Authorized Official - Phone:619-223-7171
Mailing Address - Street 1:PO BOX 60383
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92166-8383
Mailing Address - Country:US
Mailing Address - Phone:619-223-7171
Mailing Address - Fax:619-223-9065
Practice Address - Street 1:1105 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2629
Practice Address - Country:US
Practice Address - Phone:619-223-7171
Practice Address - Fax:619-223-9065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY371673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1996527OtherPK
CAPHA371670Medicaid
1062630001Medicare NSC