Organization
HOLIDAY RX INC
Active
Other names
Holiday Rx Inc
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE KATSUOCUZAKAO (VICE PRESIDENT)
(310) 738-9881
Entity
Organization
Contact information
Practice address
303 E BASELINE RD, 103, PHOENIX, AZ 85042-6530
(602) 276-5821
Mailing address
4143 VIA MARINA APT 819, MARINA DEL REY, CA 90292-5306
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
Y005095
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0355962
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/24/2009
Last updated
03/13/2009
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