Provider Demographics
NPI:1275881740
Name:SPORTPHARM PHARMACEUTICALS, INC.
Entity Type:Organization
Organization Name:SPORTPHARM PHARMACEUTICALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-451-8425
Mailing Address - Street 1:5481 COMMERCIAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1259
Mailing Address - Country:US
Mailing Address - Phone:714-451-8425
Mailing Address - Fax:877-735-4876
Practice Address - Street 1:5481 COMMERCIAL DR
Practice Address - Street 2:STE B
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1259
Practice Address - Country:US
Practice Address - Phone:714-451-8425
Practice Address - Fax:877-735-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site