Organization
MVP COMPOUNDS INC
Active
Other names
Santa Monica Medical Plaza Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOUIZ KOHANGHADOSH PHARMD (PRESIDENT/PIC)
(310) 393-6767
Entity
Organization
Contact information
Practice address
1260 15TH ST, STE 100, SANTA MONICA, CA 90404-1135
(310) 393-6767
(310) 393-6729
Mailing address
1260 15TH ST, STE 100, SANTA MONICA, CA 90404-1135
(310) 393-6767
(310) 393-6729
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY 51669
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY 51669
CA
3336C0004X
Compounding Pharmacy
PHY 51669
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0583131
NCPDP
—
01
—
PHY 51669
CALIFORNIA STATE BOARD OF PHARMACY PERMIT
CA
Enumeration date
02/14/2007
Last updated
11/26/2013
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