Provider Demographics
NPI:1407347701
Name:NRSA INC
Entity Type:Organization
Organization Name:NRSA INC
Other - Org Name:THE QR PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEVCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-397-0840
Mailing Address - Street 1:11507 OXNARD ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4185
Mailing Address - Country:US
Mailing Address - Phone:818-927-4321
Mailing Address - Fax:818-927-4325
Practice Address - Street 1:11507 OXNARD ST UNIT 2
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4186
Practice Address - Country:US
Practice Address - Phone:818-927-4321
Practice Address - Fax:818-927-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA559693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177864OtherPK