Healthcare Provider Details

I. General information

NPI: 1134537236
Provider Name (Legal Business Name): CURERX COMPOUNDING PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18625 SHERMAN WAY SUITE 107
RESEDA CA
91335-4148
US

IV. Provider business mailing address

5060 W SUNSET BLVD
LOS ANGELES CA
90027-5840
US

V. Phone/Fax

Practice location:
  • Phone: 818-881-2998
  • Fax: 818-881-2996
Mailing address:
  • Phone: 323-667-1111
  • Fax: 323-667-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 53473
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY 53473
License Number StateCA

VIII. Authorized Official

Name: MR. PHILIP ETTEDGUI
Title or Position: PRESIDENT/PIC
Credential: PHARM.D.
Phone: 818-881-2998