Organization
AMANITA RX, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEEMA PATEL (CEO)
(818) 389-6381
Entity
Organization
Contact information
Practice address
1250 LA VENTA DR, STE 114, WESTLAKE VILLAGE, CA 91361-3702
(805) 497-3974
(805) 494-0103
Mailing address
1250 LA VENTA DR, STE 114, WESTLAKE VILLAGE, CA 91361-3702
(805) 497-3974
(805) 494-0103
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY55875
CA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2132912
PK
—
Enumeration date
07/30/2006
Last updated
12/28/2017
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