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General NPI Number Information
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NPI Number | 1467883868
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Entity Type | Organization
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Legal Business Name | MEDTOWN RX INC
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Dates
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Enumeration Date | 12/10/2013
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 4128 W BURBANK BLVD
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City | BURBANK
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State | CA
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Zip | 91505
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Country | US
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Telephone | 818-500-0079
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Fax | 818-500-0225
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Provider Business Mailing Address
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Address Line | 4128 W BURBANK BLVD
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City | BURBANK
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State | CA
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Zip | 91505
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Country | US
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Telephone | 818-500-0079
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Fax | 818-500-0225
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. HOWARD RAPPAPORT
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Credential |
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Telephone | 818-500-0079
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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 | PHY55464
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License Number State | CA
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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 | PHY55464
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License Number State | CA
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