MEDICARE: ANATOMY RX LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	333600000X	Pharmacy	CA
2	3336C0004X	Compounding Pharmacy	CA
3	3336C0003X	Community/Retail Pharmacy	CA

General Provider Information

NPI Number	:	1356713226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANATOMY RX LLC

Provider Business Mailing Address
First Line	:	1544 PURDUE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3105
Country	:	US
Telephone Number	:	310-503-4779
Fax Number	:

Provider Business Practice Location Address
First Line	:	1544 PURDUE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3105
Country	:	US
Telephone Number	:	310-503-4779
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DALIBOR D KABOV
Credential	:
Telephone Number	:	310-503-4779

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	10/30/2015

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