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General NPI Number Information
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NPI Number | 1881729887
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Entity Type | Organization
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Legal Business Name | PERSONS COMPOUNDING PHARMACY, INC.
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 812 N GLENDALE AVE
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City | GLENDALE
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State | CA
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Zip | 91206
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Country | US
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Telephone | 818-243-3144
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Fax | 818-243-2171
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Provider Business Mailing Address
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Address Line | 812 N GLENDALE AVE
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City | GLENDALE
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State | CA
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Zip | 91206
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Country | US
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Telephone | 818-243-3144
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Fax | 818-243-2171
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Authorized Official
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Title or Position | CFO PIC
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Name | MISS NADIA SIMANTOV
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Credential | PHARMACIST
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Telephone | 818-243-3144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHY57442
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License Number State | CA
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