Provider Demographics
NPI:1255342747
Name:RECOVERY PHARMACEUTICALS INC
Entity type:Organization
Organization Name:RECOVERY PHARMACEUTICALS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PIC
Authorized Official - Prefix:
Authorized Official - First Name:MILAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TOSSOUN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-363-8107
Mailing Address - Street 1:16911 SAN FERNANDO MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4250
Mailing Address - Country:US
Mailing Address - Phone:818-363-8107
Mailing Address - Fax:818-831-2024
Practice Address - Street 1:16911 SAN FERNANDO MISSION BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344
Practice Address - Country:US
Practice Address - Phone:818-363-8107
Practice Address - Fax:818-831-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY471093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255342747OtherNPI
CAPHA344990Medicaid