Organization
PARK COMPOUNDING PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONY PARK PHRMD (VP)
(805) 497-8258
Entity
Organization
Contact information
Practice address
280 N WESTLAKE BLVD, STE 100, WESTLAKE VILLAGE, CA 91362-3759
(805) 497-8258
(805) 497-7548
Mailing address
280 N WESTLAKE BLVD, STE 100, WESTLAKE VILLAGE, CA 91362-3759
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHY43809
CA
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0511522
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
PHA438090
—
CA
Enumeration date
08/19/2006
Last updated
08/14/2007
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