MEDICARE: UNIVERSITY CARE RX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PHY51603	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY51603	OTHER	CA	CALIFORNIA STATE BOARD OF PHARMACY
2	56-51915	OTHER	CA	NCPDP

General Provider Information

NPI Number	:	1861828717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY CARE RX INC

Provider Business Mailing Address
First Line	:	5848 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2002
Country	:	US
Telephone Number	:	323-462-2182
Fax Number	:	323-462-2309

Provider Business Practice Location Address
First Line	:	5848 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2002
Country	:	US
Telephone Number	:	323-462-2182
Fax Number	:	323-462-2309

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. GENNADIY BIRGER
Credential	:
Telephone Number	:	323-462-2182

Provider Enumeration Date	:	09/24/2013
Last Update Date	:	07/09/2014

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Directions to “UNIVERSITY CARE RX INC ” Practice Location

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