=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477618890
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUXURY PHARMACEUTICALS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2006
-----------------------------------------------------
Last Update Date | 06/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17643 SHERMAN WAY STE 104
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91406-3510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-708-0728
-----------------------------------------------------
Fax | 818-708-1253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17643 SHERMAN WAY STE 104
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91406-3510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-708-0728
-----------------------------------------------------
Fax | 818-708-1253
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PIC
-----------------------------------------------------
Name | OLIVIA EUNKYUNG KIM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-708-0728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY48667
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------