=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679080832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECISION RX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2018
-----------------------------------------------------
Last Update Date | 09/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10680 W PICO BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90064-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-918-5818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10680 W PICO BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90064-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-918-5818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARNTER
-----------------------------------------------------
Name | BERNARD MITCHELL BUBMAN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 310-918-5818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------