Active NPI
4 M Pharmacy Inc
Doing business as JFK Medical Plaza Pharmacy
- Community/Retail Pharmacy
- Bermuda Dunes, CA
National Provider Identifier
1730226754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY48653
- Legal business name
- 4 M PHARMACY INC
- Doing business as
- JFK Medical Plaza Pharmacy
- Practice address
- 41120 Washington St
Ste 100
Bermuda Dunes, CA 92203-9215 - Phone
- (760) 772-7300
- Fax
- (760) 772-7303
- NPI assigned
- Jan 31, 2007
- Last updated
- Oct 22, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Manisha Bodi
- Title
- Mang Tech
- Phone
- (760) 772-7300
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | PHY48653 | CA | Primary |
Addresses
Primary practice location
41120 Washington St
Ste 100
Bermuda Dunes, CA 92203-9215
Mailing address
41120 Washington St
Ste 100
Bermuda Dunes, CA 92203-9215
Phone (760) 772-7300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHY416810 | Medicaid | CA | |
| 0544052 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names 1
- JFK MEDICAL PLAZA PHARMACY
National Provider Directory
National Provider Directory- Tax ID family
- 4 M Pharmacy Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1287705600000",
"number": "1730226754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41120 WASHINGTON ST",
"address_2": "STE 100",
"city": "BERMUDA DUNES",
"state": "CA",
"postal_code": "922039215",
"telephone_number": "760-772-7300",
"fax_number": "760-772-7303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41120 WASHINGTON ST",
"address_2": "STE 100",
"city": "BERMUDA DUNES",
"state": "CA",
"postal_code": "922039215",
"telephone_number": "760-772-7300",
"fax_number": "760-772-7303"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "4 M PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-31",
"last_updated": "2010-10-22",
"status": "A",
"authorized_official_last_name": "BODI",
"authorized_official_first_name": "MANISHA",
"authorized_official_title_or_position": "MANG TECH",
"authorized_official_telephone_number": "760-772-7300"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CA",
"license": "PHY48653",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PHY416810",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
"identifier": "0544052",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "JFK MEDICAL PLAZA PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bermuda Dunes, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.