Provider Demographics
NPI:1255827275
Name:UCFUSION RX LLC
Entity Type:Organization
Organization Name:UCFUSION RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUCHAVCHILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-748-1919
Mailing Address - Street 1:8222 MELROSE AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6839
Mailing Address - Country:US
Mailing Address - Phone:323-323-7504
Mailing Address - Fax:866-788-9917
Practice Address - Street 1:190 SIERRA CT STE B4
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7608
Practice Address - Country:US
Practice Address - Phone:310-748-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No333600000XSuppliersPharmacy