Healthcare Provider Details

I. General information

NPI: 1366616005
Provider Name (Legal Business Name): ADVANCED RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S ALVARADO ST STE 103
LOS ANGELES CA
90006-4184
US

IV. Provider business mailing address

13351 RIVERSIDE DR STE D STE 353
SHERMAN OAKS CA
91423-2542
US

V. Phone/Fax

Practice location:
  • Phone: 213-387-6702
  • Fax: 231-387-6703
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY49031
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH KOHAN
Title or Position: CFO
Credential:
Phone: 310-922-0272