Healthcare Provider Details

I. General information

NPI: 1588300545
Provider Name (Legal Business Name): IVI PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4766 PARK GRANADA STE 112
CALABASAS CA
91302-3347
US

IV. Provider business mailing address

4766 PARK GRANADA STE 112
CALABASAS CA
91302-3347
US

V. Phone/Fax

Practice location:
  • Phone: 818-963-7525
  • Fax: 818-963-7526
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIANNE MARQUEZ
Title or Position: SUPERVISOR
Credential:
Phone: 818-963-7525