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General NPI Number Information
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NPI Number | 1356780472
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Entity Type | Organization
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Legal Business Name | CALIFORNIA DRUG COMPOUNDING, LLC
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 6878 BECK AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91605-6205
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Country | US
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Telephone | 818-691-0286
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Fax |
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Provider Business Mailing Address
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Address Line | 6878 BECK AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91605-6205
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Country | US
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Telephone | 818-691-0286
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | IRMA DIAZ
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Credential |
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Telephone | 310-272-0894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 51459
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License Number State | CA
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