Provider Demographics
NPI:1003976424
Name:IMANOEL PHARMACY INC
Entity Type:Organization
Organization Name:IMANOEL PHARMACY INC
Other - Org Name:RX CENTRAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IMANOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-244-5152
Mailing Address - Street 1:8950 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 476
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3561
Mailing Address - Country:US
Mailing Address - Phone:818-244-5152
Mailing Address - Fax:818-244-5062
Practice Address - Street 1:800 S CENTRAL AVE
Practice Address - Street 2:STE 101A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4370
Practice Address - Country:US
Practice Address - Phone:818-244-5152
Practice Address - Fax:818-244-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA516313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142355OtherPK