Provider Demographics
NPI:1073973616
Name:ENOVEX PHARMACY LLC
Entity type:Organization
Organization Name:ENOVEX PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-242-8969
Mailing Address - Street 1:1111 N BRAND BLVD
Mailing Address - Street 2:SUITE M
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3070
Mailing Address - Country:US
Mailing Address - Phone:818-696-2501
Mailing Address - Fax:888-333-7911
Practice Address - Street 1:1111 N BRAND BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3070
Practice Address - Country:US
Practice Address - Phone:818-696-2501
Practice Address - Fax:888-333-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539433336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy