Provider Demographics
NPI:1427079482
Name:DOMEL INC.
Entity type:Organization
Organization Name:DOMEL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EIREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-658-7247
Mailing Address - Street 1:PO BOX 1497
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92546-1497
Mailing Address - Country:US
Mailing Address - Phone:951-658-7247
Mailing Address - Fax:951-658-6292
Practice Address - Street 1:156 N HARVARD ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4250
Practice Address - Country:US
Practice Address - Phone:951-658-7247
Practice Address - Fax:951-658-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY157523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1995472OtherPK
CAPHA157520Medicaid
0194470001Medicare NSC