Provider Demographics
NPI:1518092782
Name:CALIFORNIA RX NETWORK
Entity Type:Organization
Organization Name:CALIFORNIA RX NETWORK
Other - Org Name:GLENOAKS RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-846-9011
Mailing Address - Street 1:303 S GLENOAKS BLVD
Mailing Address - Street 2:STE 16
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1319
Mailing Address - Country:US
Mailing Address - Phone:818-846-9011
Mailing Address - Fax:818-845-5342
Practice Address - Street 1:303 S GLENOAKS BLVD
Practice Address - Street 2:STE 16
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1319
Practice Address - Country:US
Practice Address - Phone:818-846-9011
Practice Address - Fax:818-845-5342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2013-10-09
Deactivation Date:2008-07-30
Deactivation Code:
Reactivation Date:2009-08-26
Provider Licenses
StateLicense IDTaxonomies
CAPHY516023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5629386OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHY51602OtherCALIFORNIA STATE BOARD OF PHARMACY
5865950001Medicare NSC