Mark E Wandel

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY44374 Issued in CA

Legal business name

MARK E WANDEL

Practice address

42002 Fox Farm Rd
Suite 103
Big Bear Lake, CA 92315

Phone

(909) 866-5881

Fax

(909) 866-8510

NPI assigned

Oct 23, 2006

Organization subpart

No

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

Authorized official

Name

Mark WandelNPI 1447341490

Title

Owner

Phone

(909) 866-5881

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• BIG BEAR VALLEY MEDICAL ARTS PHARMACY Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Edward Wandel, RPH

  • Pharmacist
  • Big Bear Lake, CA
  • NPI 1447341490
  NPD (past) Authorized official

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253491200000",
    "number": "1487737532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1549",
            "city": "BIG BEAR LAKE",
            "state": "CA",
            "postal_code": "923151549",
            "telephone_number": "909-866-5881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42002 FOX FARM RD",
            "address_2": "SUITE 103",
            "city": "BIG BEAR LAKE",
            "state": "CA",
            "postal_code": "92315",
            "telephone_number": "909-866-5881",
            "fax_number": "909-866-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK E WANDEL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2009-09-21",
        "status": "A",
        "authorized_official_last_name": "WANDEL",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-866-5881"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY44374",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA443740",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0557073",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BIG BEAR VALLEY MEDICAL ARTS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Big Bear Lake, CA
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.