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General NPI Number Information
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NPI Number | 1003101999
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Entity Type | Organization
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Legal Business Name | STUDIORX INC
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Dates
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Enumeration Date | 06/19/2011
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Last Update Date | 06/19/2011
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Provider Practice Location Address
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Address Line | 937 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-1938
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Country | US
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Telephone | 323-934-8000
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Fax | 323-934-8001
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Provider Business Mailing Address
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Address Line | 937 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-1938
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Country | US
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Telephone | 323-934-8000
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Fax | 323-934-8001
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. YURI EIDELMAN
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Credential |
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Telephone | 323-934-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY50635
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License Number State | CA
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