Healthcare Provider Details

I. General information

NPI: 1447592142
Provider Name (Legal Business Name): PLATINUM RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 MADERA RD # N181
SIMI VALLEY CA
93065-3077
US

IV. Provider business mailing address

1464 MADERA RD # N181
SIMI VALLEY CA
93065-3077
US

V. Phone/Fax

Practice location:
  • Phone: 805-416-1648
  • Fax: 805-823-6519
Mailing address:
  • Phone: 805-416-1648
  • Fax: 805-823-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: KERSTIN LITVAK
Title or Position: OWNER
Credential:
Phone: 805-416-1648