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NPI Code Detail

MEDICARE: CALIFORNIA DRUG COMPOUNDING, LLC

MEDICARE: CALIFORNIA DRUG COMPOUNDING, LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
13336C0004XCompounding Pharmacy51459CA

General Provider Information

NPI Number : 1356780472
Entity Type Code : Organization
Provider Name (Legal Business Name) : CALIFORNIA DRUG COMPOUNDING, LLC
Provider Business Mailing Address
First Line : 6878 BECK AVE
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-6205
Country : US
Telephone Number : 818-691-0286
Fax Number :
Provider Business Practice Location Address
First Line : 6878 BECK AVE
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-6205
Country : US
Telephone Number : 818-691-0286
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : IRMA DIAZ
Credential :
Telephone Number : 310-272-0894
Provider Enumeration Date : 06/21/2013
Last Update Date : 06/21/2013

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