MEDICARE: GOLDEN DRUGS CO INC

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
1	3336C0004X	Compounding Pharmacy	PHY46438	CA
2	333600000X	Pharmacy	PHY46438	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0535801	OTHER	CA	NABP

General Provider Information

NPI Number	:	1982605663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN DRUGS CO INC

Provider Business Mailing Address
First Line	:	PO BOX 111318
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-9318
Country	:	US
Telephone Number	:	323-234-9956
Fax Number	:	323-234-0060

Provider Business Practice Location Address
First Line	:	4128 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2221
Country	:	US
Telephone Number	:	323-234-9956
Fax Number	:	323-234-0060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALEXANDER REZNIK
Credential	:
Telephone Number	:	323-234-9956

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	04/10/2009

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Directions to “GOLDEN DRUGS CO INC ” Practice Location

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