=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952703654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN CALIFORNIA REGIONAL INFUSION PHARMACOLOGICAL TECHNOLOGY SERV
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2014
-----------------------------------------------------
Last Update Date | 02/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13131 SHERMAN WAY SUITE 209
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91605-4646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-765-1234
-----------------------------------------------------
Fax | 818-765-1235
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13131 SHERMAN WAY SUITE 209
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91605-4646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-765-1234
-----------------------------------------------------
Fax | 818-765-1235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PIC
-----------------------------------------------------
Name | DR. ALINA GREENBERG
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 818-765-1234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PHY 52406
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | PHY 52406
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------