Healthcare Provider Details

I. General information

NPI: 1285649814
Provider Name (Legal Business Name): FRED P STARTZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8933 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90069-4912
US

IV. Provider business mailing address

8933 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90069-4912
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-7734
  • Fax: 310-278-7748
Mailing address:
  • Phone: 310-278-7734
  • Fax: 310-278-7748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY43336
License Number StateCA

VIII. Authorized Official

Name: FRED STARTZ
Title or Position: OWNER
Credential:
Phone: 310-278-7734