Healthcare Provider Details

I. General information

NPI: 1467883868
Provider Name (Legal Business Name): MEDTOWN RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4128 W BURBANK BLVD
BURBANK CA
91505
US

IV. Provider business mailing address

4128 W BURBANK BLVD
BURBANK CA
91505
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-0079
  • Fax: 818-500-0225
Mailing address:
  • Phone: 818-500-0079
  • Fax: 818-500-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY55464
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY55464
License Number StateCA

VIII. Authorized Official

Name: MR. HOWARD RAPPAPORT
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 818-500-0079