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General NPI Number Information
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NPI Number | 1568336246
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Entity Type | Organization
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Legal Business Name | AMANITA RX, INC.
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 1250 LA VENTA DR STE 114
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-3762
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Country | US
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Telephone | 805-497-3974
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 LA VENTA DR STE 114
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-3762
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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 | CEO
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Name | SEEMA PATEL
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Credential |
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Telephone | 818-389-6381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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