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General NPI Number Information
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NPI Number | 1144457078
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Entity Type | Organization
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Legal Business Name | RX BIOTECH PHARMACY LLC
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 2514 N ONTARIO ST STE 102
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City | BURBANK
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State | CA
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Zip | 91504-2512
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Country | US
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Telephone | 310-657-2212
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Fax | 310-657-0906
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Provider Business Mailing Address
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Address Line | 2929 WALKER AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49544-6402
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Country | US
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Telephone | 616-791-3346
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT, PHARMACY
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Name | JASON BEAUCH
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Credential |
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Telephone | 616-791-3346
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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 | 53842
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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