Provider Demographics
NPI:1457422479
Name:RX INGREDIENTS INC
Entity Type:Organization
Organization Name:RX INGREDIENTS INC
Other - Org Name:RX INGREDIENTS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZRILYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-849-5611
Mailing Address - Street 1:7107 VALJEAN AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3917
Mailing Address - Country:US
Mailing Address - Phone:818-849-5611
Mailing Address - Fax:818-646-0308
Practice Address - Street 1:7107 VALJEAN AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3917
Practice Address - Country:US
Practice Address - Phone:818-849-5611
Practice Address - Fax:818-646-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY483153336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457422479Medicaid
2111954OtherPK