Provider Demographics
NPI:1487898631
Name:LA JOLLA DISCOUNT COMPOUNDING
Entity type:Organization
Organization Name:LA JOLLA DISCOUNT COMPOUNDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHAYAKEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:858-622-1800
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1224
Mailing Address - Country:US
Mailing Address - Phone:858-622-1800
Mailing Address - Fax:858-622-1803
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-622-1800
Practice Address - Fax:858-622-1803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASHAY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALSC 992453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy