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General NPI Number Information
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NPI Number | 1457621518
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Entity Type | Organization
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Legal Business Name | MEDICO SPECIALTY PHARMACY INC
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 7039 VALJEAN AVE #B
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City | VAN NUYS
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State | CA
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Zip | 91406-3915
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Country | US
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Telephone | 818-582-3517
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Fax | 818-453-8928
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Provider Business Mailing Address
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Address Line | 7039 VALJEAN AVE #B
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City | VAN NUYS
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State | CA
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Zip | 91406-3915
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Country | US
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Telephone | 818-582-3517
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Fax | 818-453-8928
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Authorized Official
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Title or Position | PRESIDENT/PHARMACIST
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Name | MR. VLADIMIR LENCHITSKY
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Credential | PHARM D
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Telephone | 818-582-3517
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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 | PHY 50778
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | PHY50778
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License Number State | CA
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