Healthcare Provider Details

I. General information

NPI: 1851769012
Provider Name (Legal Business Name): JUSTICE RX GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 LONG BEACH BLVD
LONG BEACH CA
90806-3260
US

IV. Provider business mailing address

2980 N BEVERLY GLEN CIR STE 100
LOS ANGELES CA
90077-1728
US

V. Phone/Fax

Practice location:
  • Phone: 562-612-0950
  • Fax:
Mailing address:
  • Phone: 310-943-4180
  • Fax: 888-431-8819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberG73514
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID S. SILVER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 562-612-0950