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General NPI Number Information
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NPI Number | 1578748877
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Entity Type | Organization
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Legal Business Name | IRDGAS
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 01/04/2008
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Provider Practice Location Address
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Address Line | 9375 SAN FERNANDO RD
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City | SUN VALLEY
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State | CA
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Zip | 91352-1418
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Country | US
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Telephone | 818-768-3322
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Fax | 818-504-0418
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Provider Business Mailing Address
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Address Line | 9375 SAN FERNANDO RD
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City | SUN VALLEY
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State | CA
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Zip | 91352-1418
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Country | US
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Telephone | 818-768-3322
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Fax | 818-504-0418
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD DENNIS MANZANI
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Credential | PHARM. D.
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Telephone | 818-768-3322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | PHY406210
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License Number State | CA
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