Provider Demographics
NPI:1790945343
Name:PREFERRED RX, INC.
Entity Type:Organization
Organization Name:PREFERRED RX, INC.
Other - Org Name:RODEO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-459-0785
Mailing Address - Street 1:3560 S LA CIENEGA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-4400
Mailing Address - Country:US
Mailing Address - Phone:323-939-3900
Mailing Address - Fax:323-939-3909
Practice Address - Street 1:3560 S LA CIENEGA BLVD STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4400
Practice Address - Country:US
Practice Address - Phone:323-939-3900
Practice Address - Fax:323-939-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49091OtherCALIFORNIA BOARD OF PHARMACY PERMIT NUMBER
CA6465770001Medicare NSC