Provider Demographics
NPI:1538350541
Name:WHOLERX INC
Entity type:Organization
Organization Name:WHOLERX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOJDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-360-1915
Mailing Address - Street 1:19950 RINALDI ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4141
Mailing Address - Country:US
Mailing Address - Phone:818-360-1915
Mailing Address - Fax:818-368-4987
Practice Address - Street 1:19950 RINALDI ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4141
Practice Address - Country:US
Practice Address - Phone:818-360-1915
Practice Address - Fax:818-368-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538350541Medicaid
2112565OtherPK