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General NPI Number Information
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NPI Number | 1316123334
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Entity Type | Organization
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Legal Business Name | CLINICAL COMPOUNDING PHARMACY
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 8941 SANTA MONICA BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-4912
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Country | US
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Telephone | 323-650-0025
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Fax | 323-650-0029
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Provider Business Mailing Address
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Address Line | 8941 SANTA MONICA BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-4912
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Country | US
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Telephone | 323-650-0025
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Fax | 323-650-0029
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Authorized Official
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Title or Position | PRESIDENT/PIC
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Name | HELEN KIZLER
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Credential |
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Telephone | 323-650-0025
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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 | 50743
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License Number State | CA
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