Provider Demographics
NPI:1922406172
Name:VAN NUYS RX INC
Entity Type:Organization
Organization Name:VAN NUYS RX INC
Other - Org Name:VAN NUYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-739-9507
Mailing Address - Street 1:16000 VENTURA BLVD
Mailing Address - Street 2:STE 760
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2744
Mailing Address - Country:US
Mailing Address - Phone:818-739-9507
Mailing Address - Fax:818-988-2003
Practice Address - Street 1:6365 VAN NUYS BLVD
Practice Address - Street 2:STE A
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2639
Practice Address - Country:US
Practice Address - Phone:818-739-9507
Practice Address - Fax:818-988-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 525453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56-53553OtherNCPDP PROVIDER NUMBER