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Provider Information for 1891982096


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LA VITA COMPOUNDING PHARMACY LLC

Other Names:  
Doing Business As: 
LA VITA COMPOUNDING PHARMACY

Organization Subpart: NO

NPI: 1891982096
Last Updated: 2022-11-15
Certification Date: 2022-11-15

Details

NameValue
NPI1891982096
Enumeration Date2007-10-02
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: CHRISTINE GIVANT RPH
Title: OWNER
Phone: 8584532500
Mailing Address 11468 SORRENTO VALLEY RD STE C
SAN DIEGO, CA 92121-1347
United States

Phone: 858-453-2500 | Fax:858-453-2501
 
Primary Practice Address 11468 SORRENTO VALLEY RD STE C
SAN DIEGO, CA 92121-1347
United States

Phone: 858-453-2500 | Fax:858-453-2501
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)5628308NCPDP Provider Identification Number
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
No 3336M0002X - Pharmacy - Mail Order Pharmacy
Yes 3336C0004X - Pharmacy - Compounding PharmacyCA48731