Provider Demographics
NPI:1467518746
Name:LA VOTRE RX
Entity Type:Organization
Organization Name:LA VOTRE RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABERGEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:661-259-8039
Mailing Address - Street 1:23928 LYONS AVE
Mailing Address - Street 2:102
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2409
Mailing Address - Country:US
Mailing Address - Phone:661-259-8039
Mailing Address - Fax:661-259-8411
Practice Address - Street 1:23928 LYONS AVE
Practice Address - Street 2:102
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2409
Practice Address - Country:US
Practice Address - Phone:661-259-8039
Practice Address - Fax:661-259-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA437033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA437030Medicaid
CA1263170001Medicare ID - Type Unspecified