1922406172 NPI number — VAN NUYS RX INC

Table of content: (NPI 1922406172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922406172 NPI number — VAN NUYS RX INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VAN NUYS RX INC
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:
VAN NUYS 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:
1922406172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16000 VENTURA BLVD
Provider Second Line Business Mailing Address:
STE 760
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91436-2744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-739-9507
Provider Business Mailing Address Fax Number:
818-988-2003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6365 VAN NUYS BLVD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91401-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-739-9507
Provider Business Practice Location Address Fax Number:
818-988-2003
Provider Enumeration Date:
12/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDMEN
Authorized Official First Name:
ALEX
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
818-739-9507

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY 52545 , 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: 56-53553 . This is a "NCPDP PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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