MEDICARE: COMPOUNDING PHARMACY OF BEVERLY HILLS

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	183500000X	Pharmacist	PHY43111	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY43111	OTHER	CA	PHARMACY STATE LICENSE #
2	0580921	OTHER	CA	NABP NUMBER

General Provider Information

NPI Number	:	1962541631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPOUNDING PHARMACY OF BEVERLY HILLS

Provider Business Mailing Address
First Line	:	9629 W OLYMPIC BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3716
Country	:	US
Telephone Number	:	310-284-8675
Fax Number	:	310-284-8680

Provider Business Practice Location Address
First Line	:	9629 W OLYMPIC BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3716
Country	:	US
Telephone Number	:	310-284-8675
Fax Number	:	310-284-8680

Authorized Official
Title or Position	:	PHARMACIST-IN-CHARGE
Name	:	DR. ELYSE FILDERMAN
Credential	:
Telephone Number	:	310-284-8675

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	06/18/2008

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Directions to “COMPOUNDING PHARMACY OF BEVERLY HILLS ” Practice Location

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