Provider Demographics
NPI:1760789614
Name:PHARMACY MANAGEMENT ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PHARMACY MANAGEMENT ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:949-735-5256
Mailing Address - Street 1:28241 CROWN VALLEY PKWY
Mailing Address - Street 2:#616
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4441
Mailing Address - Country:US
Mailing Address - Phone:949-735-5256
Mailing Address - Fax:949-643-9477
Practice Address - Street 1:28241 CROWN VALLEY PARKWAY
Practice Address - Street 2:#616
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-735-5256
Practice Address - Fax:949-643-9477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITELEY CHIROPRACTIC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305861835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAY620Medicare PIN