Provider Demographics
NPI:1053454561
Name:MVP COMPOUNDS INC
Entity Type:Organization
Organization Name:MVP COMPOUNDS INC
Other - Org Name:SANTA MONICA MEDICAL PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MOUIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHANGHADOSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:310-393-6767
Mailing Address - Street 1:1260 15TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1135
Mailing Address - Country:US
Mailing Address - Phone:310-393-6767
Mailing Address - Fax:310-393-6729
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:STE 100
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1135
Practice Address - Country:US
Practice Address - Phone:310-393-6767
Practice Address - Fax:310-393-6729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 51669333600000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0583131OtherNCPDP
CAPHY 51669OtherCALIFORNIA STATE BOARD OF PHARMACY PERMIT