Provider Demographics
NPI:1659824837
Name:DAP HEALTH
Entity Type:Organization
Organization Name:DAP HEALTH
Other - Org Name:DBA STONEWALL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-323-2118
Mailing Address - Street 1:1695 N SUNRISE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-323-2118
Mailing Address - Fax:858-634-6931
Practice Address - Street 1:68555 RAMON ROAD
Practice Address - Street 2:SUITE D105
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234
Practice Address - Country:US
Practice Address - Phone:760-767-3047
Practice Address - Fax:858-635-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
CAPHY546253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166135OtherPK