Provider Demographics
NPI:1316304611
Name:ARCHANGEL MICHAEL PHARMACY INC
Entity type:Organization
Organization Name:ARCHANGEL MICHAEL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/AO/PIC
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-302-7733
Mailing Address - Street 1:31754 TEMECULA PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6805
Mailing Address - Country:US
Mailing Address - Phone:951-302-7733
Mailing Address - Fax:951-302-7717
Practice Address - Street 1:31754 TEMECULA PKWY STE D
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6805
Practice Address - Country:US
Practice Address - Phone:951-302-7733
Practice Address - Fax:951-302-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY542833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157861OtherPK