Healthcare Provider Details

I. General information

NPI: 1962693234
Provider Name (Legal Business Name): PHARMIX CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2007
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 E SUNSET RD SUITE 120
LAS VEGAS NV
89120-3516
US

IV. Provider business mailing address

414 N CAMDEN DR SUITE 750
BEVERLY HILLS CA
90210-4532
US

V. Phone/Fax

Practice location:
  • Phone: 702-541-6023
  • Fax: 702-405-8135
Mailing address:
  • Phone: 310-247-1300
  • Fax: 310-205-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberPH02254
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH02254
License Number StateNV

VIII. Authorized Official

Name: DR. DANIEL IRWIN GELBER
Title or Position: MANAGING MEMBER
Credential: PHARM.D.
Phone: 818-642-6450