Provider Demographics
NPI:1689778631
Name:DOMEL INC.
Entity Type:Organization
Organization Name:DOMEL INC.
Other - Org Name:SAIL DRUG AND DISCOUNT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EIREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-658-7247
Mailing Address - Street 1:PO BOX 1497
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92546-1497
Mailing Address - Country:US
Mailing Address - Phone:909-797-9191
Mailing Address - Fax:
Practice Address - Street 1:12350 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4404
Practice Address - Country:US
Practice Address - Phone:909-797-9191
Practice Address - Fax:909-797-4784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY183053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA183050Medicaid
1995688OtherPK
CAPHA183050Medicaid