Organization
PETICUB
Active
Other names
Peticub
Organization subpart
No
Provider details
NPI number
Authorized official
RABIN SHAOULIAN (LOCATION MANAGER)
(310) 839-7387
Entity
Organization
Contact information
Practice address
1804 S LA CIENEGA BLVD # 102, LOS ANGELES, CA 90035-4670
(310) 839-7387
(310) 288-9141
Mailing address
1804 S LA CIENEGA BLVD # 102, LOS ANGELES, CA 90035-4670
(310) 839-7387
(310) 288-9141
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5644821
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/27/2012
Last updated
08/21/2012
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up