Provider Demographics
NPI:1336422989
Name:INSPIRED COMPOUNDS INC
Entity Type:Organization
Organization Name:INSPIRED COMPOUNDS INC
Other - Org Name:RODEO DRIVE ANTI-AGING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-247-8004
Mailing Address - Street 1:421 N RODEO DR
Mailing Address - Street 2:P4
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4500
Mailing Address - Country:US
Mailing Address - Phone:310-247-8004
Mailing Address - Fax:310-247-8015
Practice Address - Street 1:421 N RODEO DR
Practice Address - Street 2:P4
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4500
Practice Address - Country:US
Practice Address - Phone:310-247-8004
Practice Address - Fax:310-247-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50728333600000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY50728OtherRETAIL PHARMACY PERMIT