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General NPI Number Information
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NPI Number | 1063652584
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Entity Type | Organization
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Legal Business Name | HOLIDAY RX INC
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 303 E BASELINE RD 103
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City | PHOENIX
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State | AZ
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Zip | 85042-6530
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Country | US
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Telephone | 602-276-5821
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Fax |
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Provider Business Mailing Address
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Address Line | 4143 VIA MARINA APT 819
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | LANCE KATSUOCUZAKAO
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Credential |
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Telephone | 310-738-9881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | Y005095
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License Number State | AZ
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