Provider Demographics
NPI:1871959189
Name:MZMZ CORP.
Entity type:Organization
Organization Name:MZMZ CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-268-6028
Mailing Address - Street 1:17609 VENTURA BLVD
Mailing Address - Street 2:LL06
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3858
Mailing Address - Country:US
Mailing Address - Phone:818-464-4988
Mailing Address - Fax:818-464-4989
Practice Address - Street 1:17609 VENTURA BLVD STE LL06
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5137
Practice Address - Country:US
Practice Address - Phone:818-464-4988
Practice Address - Fax:818-464-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58321333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2156128OtherPK