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Organization
LA VITA COMPOUNDING PHARMACY LLC
Active
Organization
LA VITA COMPOUNDING PHARMACY LLC
Active
Other names
LA VITA COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE GIVANT RPH (OWNER)
(858) 453-2500
Entity
Organization
Contact information
Practice address
11468 SORRENTO VALLEY RD STE C, SAN DIEGO, CA 92121-1347
(858) 453-2500
(858) 453-2501
Mailing address
11468 SORRENTO VALLEY RD STE C, SAN DIEGO, CA 92121-1347
(858) 453-2500
(858) 453-2501
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
48731
CA
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5628308
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/02/2007
Last updated
11/15/2022
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