Healthcare Provider Details

I. General information

NPI: 1982605663
Provider Name (Legal Business Name): GOLDEN DRUGS CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4128 S BROADWAY
LOS ANGELES CA
90037-2221
US

IV. Provider business mailing address

PO BOX 111318
LOS ANGELES CA
90011-9318
US

V. Phone/Fax

Practice location:
  • Phone: 323-234-9956
  • Fax: 323-234-0060
Mailing address:
  • Phone: 323-234-9956
  • Fax: 323-234-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY46438
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY46438
License Number StateCA

VIII. Authorized Official

Name: MR. ALEXANDER REZNIK
Title or Position: PRESIDENT
Credential:
Phone: 323-234-9956