Healthcare Provider Details

I. General information

NPI: 1285708719
Provider Name (Legal Business Name): RECOMBI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N WESTLAKE BLVD STE 250
WESTLAKE VILLAGE CA
91362-3700
US

IV. Provider business mailing address

250 N WESTLAKE BLVD STE 250
WESTLAKE VILLAGE CA
91362-3700
US

V. Phone/Fax

Practice location:
  • Phone: 805-496-4202
  • Fax: 866-222-6636
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number48231
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. TONY PARK
Title or Position: PHARMACIST PRESIDENT CEO
Credential: PHARMD
Phone: 805-208-4140