Healthcare Provider Details

I. General information

NPI: 1154820249
Provider Name (Legal Business Name): COMPOUNDIA RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 LAKEFIELD RD STE E
WESTLAKE VILLAGE CA
91361-2661
US

IV. Provider business mailing address

766 LAKEFIELD RD SUITE E
WESTLAKE VILLAGE CA
91361
US

V. Phone/Fax

Practice location:
  • Phone: 805-371-4443
  • Fax: 804-371-4375
Mailing address:
  • Phone: 805-371-4443
  • Fax: 804-371-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number56030
License Number StateCA

VIII. Authorized Official

Name: ANGELIK KARAPETIAN
Title or Position: PRESIDENT
Credential:
Phone: 323-229-5478