Healthcare Provider Details

I. General information

NPI: 1245469295
Provider Name (Legal Business Name): FMP ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13237 SATICOY ST #4
NORTH HOLLYWOOD CA
91605-3432
US

IV. Provider business mailing address

5335 LAUREL CANYON BLVD
NORTH HOLLYWOOD CA
91607-2711
US

V. Phone/Fax

Practice location:
  • Phone: 818-985-1814
  • Fax: 818-985-5005
Mailing address:
  • Phone: 818-985-1814
  • Fax: 818-985-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY 46616
License Number StateCA

VIII. Authorized Official

Name: MR. MARK HOWARD DEUTSCH
Title or Position: MEMBER
Credential:
Phone: 818-985-1814