Organization
FMP ENTERPRISES, LLC
Active
Other names
Tricare Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK HOWARD DEUTSCH (MEMBER)
(818) 985-1814
Entity
Organization
Contact information
Practice address
13237 SATICOY ST, #4, NORTH HOLLYWOOD, CA 91605-3432
(818) 985-1814
(818) 985-5005
Mailing address
5335 LAUREL CANYON BLVD, NORTH HOLLYWOOD, CA 91607-2711
(818) 985-1814
(818) 985-5005
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PHY 46616
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA466160
—
CA
Enumeration date
07/13/2009
Last updated
07/13/2009
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