Provider Demographics
NPI:1023354032
Name:MY PERSONAL MULTIVITAMIN, LLC
Entity type:Organization
Organization Name:MY PERSONAL MULTIVITAMIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:EVA
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:847-754-1131
Mailing Address - Street 1:10305 E STAR OF THE DESERT DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255
Mailing Address - Country:US
Mailing Address - Phone:847-754-1131
Mailing Address - Fax:
Practice Address - Street 1:10305 E STAR OF THE DESERT DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8625
Practice Address - Country:US
Practice Address - Phone:847-754-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ999431133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1063731529Medicare PIN