| NPI | 1336422989 |
|---|---|
| Doing Business As | RODEO DRIVE ANTI-AGING PHARMACY |
| Entity Type | Organization |
| Authorized Contact | MICHAEL C HUA President/PIC 310-247-8004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CA PHY50728) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: CA PHY50728) |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: CA PHY50728) | |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2011-09-21 |