Healthcare Provider Details

I. General information

NPI: 1922406172
Provider Name (Legal Business Name): VAN NUYS RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6365 VAN NUYS BLVD STE A
VAN NUYS CA
91401-2639
US

IV. Provider business mailing address

16000 VENTURA BLVD STE 760
ENCINO CA
91436-2744
US

V. Phone/Fax

Practice location:
  • Phone: 818-739-9507
  • Fax: 818-988-2003
Mailing address:
  • Phone: 818-739-9507
  • Fax: 818-988-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 52545
License Number StateCA

VIII. Authorized Official

Name: MR. ALEX GOLDMEN
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 818-739-9507