Provider Demographics
NPI:1821454554
Name:BEVERLY HILLS APOTHECARY LLC
Entity Type:Organization
Organization Name:BEVERLY HILLS APOTHECARY LLC
Other - Org Name:BEVERLY HILLS APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:ROSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:310-213-8884
Mailing Address - Street 1:432 N BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4301
Mailing Address - Country:US
Mailing Address - Phone:310-741-4596
Mailing Address - Fax:310-741-4597
Practice Address - Street 1:432 N BEDFORD DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4301
Practice Address - Country:US
Practice Address - Phone:310-741-4596
Practice Address - Fax:310-741-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY537403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157504OtherPK