1518092782 NPI number — CALIFORNIA RX NETWORK

Table of content: DR. CHARLES EDWIN OLVER PHARM.D. (NPI 1154678514)

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:
Provider Other Organization Name Type Code:
6
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".




Copyright © 2007-2025 www.npivalidator.com