| NPI | 1528254885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH JACK AMODEO Pharmacist In Charge 818-857-9217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: CA 48647) |
| Additional Taxonomies | 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: CA 48647) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2010-09-27 |