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General NPI Number Information
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NPI Number | 1366616005
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Entity Type | Organization
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Legal Business Name | ADVANCED RX INC
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 1107 S ALVARADO ST STE 103
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City | LOS ANGELES
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State | CA
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Zip | 90006-4184
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Country | US
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Telephone | 213-387-6702
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Fax | 231-387-6703
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Provider Business Mailing Address
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Address Line | 13351 RIVERSIDE DR STE D STE 353
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2542
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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 | CFO
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Name | JOSEPH KOHAN
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Credential |
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Telephone | 310-922-0272
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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 |
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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 | PHY49031
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License Number State | CA
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