Amanita RX, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY55875 Issued in CA

Legal business name

AMANITA RX, INC.

Practice address

1250 La Venta Dr
Ste 114
Westlake Village, CA 91361-3702

Phone

(805) 497-3974

Fax

(805) 494-0103

NPI assigned

Jul 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Seema PatelNPI 1275406449

Title

Ceo

Phone

(818) 389-6381

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Amanita RX Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Amanita RX, Inc.

  • Long Term Care Pharmacy
  • Westlake Village, CA
  • NPI 1568336246
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Seema Patel

  • Community/Retail Pharmacy
  • Westlake Village, CA
  • NPI 1275406449
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514419200000",
    "number": "1285649897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 LA VENTA DR",
            "address_2": "STE 114",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913613702",
            "telephone_number": "805-497-3974",
            "fax_number": "805-494-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 LA VENTA DR",
            "address_2": "STE 114",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913613702",
            "telephone_number": "805-497-3974",
            "fax_number": "805-494-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMANITA RX, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2017-12-28",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "SEEMA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-389-6381"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY55875",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2132912",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Westlake Village, CA
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.