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General NPI Number Information
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NPI Number | 1447646518
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Entity Type | Organization
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Legal Business Name | COLORADO PHARMACY INC
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 06/09/2016
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Provider Practice Location Address
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Address Line | 2455 COLORADO BLVD APT 6
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City | LOS ANGELES
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State | CA
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Zip | 90041-1182
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Country | US
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Telephone | 323-739-0011
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Fax | 323-474-6012
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Provider Business Mailing Address
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Address Line | 2455 COLORADO BLVD SPACE # 6
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City | LOS ANGELES
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State | CA
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Zip | 90041-1170
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Country | US
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Telephone | 323-739-0011
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Fax | 323-474-6012
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | VADIM BELITSKY
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Credential |
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Telephone | 323-739-0011
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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 | PHY52413
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License Number State | CA
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