Healthcare Provider Details

I. General information

NPI: 1972688463
Provider Name (Legal Business Name): CRESCENT DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 BLACKWELDER ST
CULVER CITY CA
90232-7305
US

IV. Provider business mailing address

5915 BLACKWELDER ST
CULVER CITY CA
90232-7305
US

V. Phone/Fax

Practice location:
  • Phone: 310-558-1400
  • Fax: 310-558-1417
Mailing address:
  • Phone: 310-558-1400
  • Fax: 310-558-1417

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 Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50359
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID NAGHI
Title or Position: PRESIDENT
Credential:
Phone: 310-558-1400