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General NPI Number Information
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NPI Number | 1306939731
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Entity Type | Organization
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Legal Business Name | LDW PC INC
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 9400 BRIGHTON WAY
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4714
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Country | US
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Telephone | 310-274-0144
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Fax | 310-275-5470
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Provider Business Mailing Address
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Address Line | 9400 BRIGHTON WAY
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4714
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Country | US
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Telephone | 310-274-0144
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Fax | 310-275-5470
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Authorized Official
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Title or Position | CHIEF PHCST
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Name | PETER DOLEZAL
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Credential |
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Telephone | 310-274-0144
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY46072
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License Number State | CA
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