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General NPI Number Information
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NPI Number | 1922343482
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Entity Type | Organization
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Legal Business Name | MICKEY FINE ENTERPRISES INC
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 2000 AVENUE OF THE STARS
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City | LOS ANGELES
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State | CA
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Zip | 90067-4700
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Country | US
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Telephone | 310-277-6123
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Fax | 310-277-6128
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Provider Business Mailing Address
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Address Line | 2000 AVENUE OF THE STARS
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City | LOS ANGELES
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State | CA
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Zip | 90067-4700
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Country | US
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Telephone | 310-277-6123
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Fax | 310-277-6128
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY GROSS
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Credential |
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Telephone | 310-277-6123
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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 | PHY52590
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License Number State | CA
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