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General NPI Number Information
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NPI Number | 1790228468
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Entity Type | Organization
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Legal Business Name | MAC CARE RX INC
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 18075 VENTURA BLVD #112
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City | ENCINO
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State | CA
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Zip | 91316-3593
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Country | US
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Telephone | 818-975-8612
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Fax | 818-975-8613
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Provider Business Mailing Address
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Address Line | 18075 VENTURA BLVD #112
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City | ENCINO
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State | CA
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Zip | 91316-3593
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Country | US
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Telephone | 818-975-8612
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Fax | 818-975-8613
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. ILYA ZIKNER
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Credential |
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Telephone | 818-975-8612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | CA
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