1518092782 NPI number — CALIFORNIA RX NETWORK

Table of content: (NPI 1518092782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518092782 NPI number — CALIFORNIA RX NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA RX NETWORK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GLENOAKS RX PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518092782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/30/2008
NPI Reactivation Date:
08/26/2009

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 S GLENOAKS BLVD
Provider Second Line Business Mailing Address:
STE 16
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91502-1319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-846-9011
Provider Business Mailing Address Fax Number:
818-845-5342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 S GLENOAKS BLVD
Provider Second Line Business Practice Location Address:
STE 16
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91502-1319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-846-9011
Provider Business Practice Location Address Fax Number:
818-845-5342
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHALTS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/PIC
Authorized Official Telephone Number:
818-846-9011

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY51602 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5629386 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: PHY51602 . This is a "CALIFORNIA STATE BOARD OF PHARMACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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