Healthcare Provider Details

I. General information

NPI: 1255422085
Provider Name (Legal Business Name): LAX PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4457 LENNOX BLVD
LENNOX CA
90304-2303
US

IV. Provider business mailing address

4457 LENNOX BLVD
LENNOX CA
90304-2303
US

V. Phone/Fax

Practice location:
  • Phone: 310-674-1403
  • Fax: 310-674-1421
Mailing address:
  • Phone: 310-674-1403
  • Fax: 310-674-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY48895
License Number StateCA

VIII. Authorized Official

Name: MICHAEL AHDOUT
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 310-674-1403