Healthcare Provider Details

I. General information

NPI: 1457348492
Provider Name (Legal Business Name): MIZBES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22277 MULHOLLAND HWY
CALABASAS CA
91302-5156
US

IV. Provider business mailing address

22277 MULHOLLAND HWY
CALABASAS CA
91302-5156
US

V. Phone/Fax

Practice location:
  • Phone: 818-223-8656
  • Fax: 818-223-8750
Mailing address:
  • Phone: 818-223-8656
  • Fax: 818-223-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY41379
License Number StateCA

VIII. Authorized Official

Name: BRENDA SUE JOHNSON
Title or Position: OWNER
Credential: RPH
Phone: 818-233-8656