Healthcare Provider Details

I. General information

NPI: 1275263204
Provider Name (Legal Business Name): LA CARE RX, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15243 VANOWEN ST STE 100
VAN NUYS CA
91405-3635
US

IV. Provider business mailing address

15243 VANOWEN ST STE 100
VAN NUYS CA
91405-3635
US

V. Phone/Fax

Practice location:
  • Phone: 818-523-7700
  • Fax:
Mailing address:
  • Phone: 818-523-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SERGEY HAKOBYAN
Title or Position: OWNER
Credential:
Phone: 818-394-6521