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Organization
CUSTOM RX PHARMACY
Active
Organization
CUSTOM RX PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL IMANOEL (PHARMACIST (PRESIDENT))
(323) 937-7879
Entity
Organization
Contact information
Practice address
731 1/2 N LA BREA AVE, LOS ANGELES, CA 90038-3338
(323) 937-7879
Mailing address
PO BOX 48408, LOS ANGELES, CA 90048-0408
(323) 937-7879
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
46817710
CA
Other
Enumeration date
10/20/2006
Last updated
08/24/2009
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