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General NPI Number Information
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NPI Number | 1053454561
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Entity Type | Organization
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Legal Business Name | MVP COMPOUNDS INC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 1260 15TH ST STE 100
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City | SANTA MONICA
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State | CA
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Zip | 90404-1135
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Country | US
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Telephone | 310-393-6767
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Fax | 310-393-6729
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Provider Business Mailing Address
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Address Line | 1260 15TH ST STE 100
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City | SANTA MONICA
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State | CA
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Zip | 90404-1135
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Country | US
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Telephone | 310-393-6767
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Fax | 310-393-6729
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Authorized Official
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Title or Position | PRESIDENT/PIC
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Name | DR. MOUIZ KOHANGHADOSH
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Credential | PHARMD
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Telephone | 310-393-6767
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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 | PHY 51669
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PHY 51669
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY 51669
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License Number State | CA
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