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General NPI Number Information
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NPI Number | 1922406172
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Entity Type | Organization
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Legal Business Name | VAN NUYS RX INC
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Dates
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Enumeration Date | 12/19/2014
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 6365 VAN NUYS BLVD STE A
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City | VAN NUYS
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State | CA
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Zip | 91401-2639
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Country | US
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Telephone | 818-739-9507
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Fax | 818-988-2003
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Provider Business Mailing Address
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Address Line | 16000 VENTURA BLVD STE 760
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City | ENCINO
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State | CA
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Zip | 91436-2744
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Country | US
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Telephone | 818-739-9507
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Fax | 818-988-2003
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. ALEX GOLDMEN
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Credential |
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Telephone | 818-739-9507
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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 | PHY 52545
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License Number State | CA
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