Provider Demographics
NPI:1962541631
Name:COMPOUNDING PHARMACY OF BEVERLY HILLS
Entity type:Organization
Organization Name:COMPOUNDING PHARMACY OF BEVERLY HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-284-8675
Mailing Address - Street 1:9629 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3716
Mailing Address - Country:US
Mailing Address - Phone:310-284-8675
Mailing Address - Fax:310-284-8680
Practice Address - Street 1:9629 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3716
Practice Address - Country:US
Practice Address - Phone:310-284-8675
Practice Address - Fax:310-284-8680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SECUNDUM ARTEM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY43111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY43111OtherPHARMACY STATE LICENSE #
CA0580921OtherNABP NUMBER