Healthcare Provider Details

I. General information

NPI: 1275960221
Provider Name (Legal Business Name): BIONIX PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2013
Last Update Date: 10/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6862 HAYVENHURST AVE
VAN NUYS CA
91406-4717
US

IV. Provider business mailing address

6862 HAYVENHURST AVE
VAN NUYS CA
91406-4717
US

V. Phone/Fax

Practice location:
  • Phone: 866-535-8752
  • Fax: 866-535-8752
Mailing address:
  • Phone: 866-535-8752
  • Fax: 866-535-8752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN TORRES
Title or Position: MANAGEMENT
Credential:
Phone: 866-535-8752