NPIMap

Organization Active NPI

MDM Pharmacy Services 2

Doing business as New Pharmacy 2

  • Community/Retail Pharmacy
  • Twentynine Palms, CA
National Provider Identifier
1033591540
Registry record updated Apr 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY52555 Issued in CA
Legal business name
MDM PHARMACY SERVICES 2
Doing business as
New Pharmacy 2
Practice address
72724 29 Palms Hwy Ste 104
Twentynine Palms, CA 92277-2459
Phone
(760) 367-2000
Fax
(760) 367-2001
NPI assigned
Jun 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Maher Michail, RPH
Title
Owner / Pic/ Ao
Phone
(760) 851-8120

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY52555 CA Primary

Addresses

Primary practice location

72724 29 Palms Hwy Ste 104
Twentynine Palms, CA 92277-2459

Mailing address

57725 29 Palms Hwy
Ste 209
Yucca Valley, CA 92284-3044
Phone (760) 228-1600

Other identifiers 1

IdentifierTypeStateIssuer
2152780OtherPK

Other names 1

  • New Pharmacy 2 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201130001716 CA Part B Supplier - Mass Immunization (Roster Biller Only) 2264843036 Practice locations: Twentynine Palms, CA

National Provider Directory

National Provider Directory
Tax ID family
MDM Pharmacy Services 22 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

72724 29 Palms Hwy
Ste 209
Twentynine Palms, CA 92277
Phone (760) 851-8120

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492387200000",
    "number": "1033591540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57725 29 PALMS HWY",
            "address_2": "STE 209",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922843044",
            "telephone_number": "760-228-1600",
            "fax_number": "760-228-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72724 29 PALMS HWY STE 104",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "922772459",
            "telephone_number": "760-367-2000",
            "fax_number": "760-367-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDM PHARMACY SERVICES 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-20",
        "last_updated": "2017-04-17",
        "status": "A",
        "authorized_official_last_name": "MICHAIL",
        "authorized_official_first_name": "MAHER",
        "authorized_official_title_or_position": "OWNER / PIC/ AO",
        "authorized_official_telephone_number": "760-851-8120",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY52555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2152780",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Pharmacy 2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Twentynine Palms, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.