Provider Demographics
NPI:1871801449
Name:4MINERMEDS.COM INC
Entity type:Organization
Organization Name:4MINERMEDS.COM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SEANN
Authorized Official - Middle Name:STEPEHN
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-790-6278
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-1924
Mailing Address - Country:US
Mailing Address - Phone:951-790-6278
Mailing Address - Fax:
Practice Address - Street 1:11854 BRIAR KNOLL PL
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-6229
Practice Address - Country:US
Practice Address - Phone:951-790-6278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy