1972584118 NPI number — REINA SY

Table of content: (NPI 1972584118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972584118 NPI number — REINA SY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REINA SY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972584118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4526 EAGLE ROCK BLVD
Provider Second Line Business Mailing Address:
STE 4
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90041-3285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7220 ROSEMEAD BLVD
Provider Second Line Business Practice Location Address:
STE 202-7
Provider Business Practice Location Address City Name:
SAN GABRIEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91775-1377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-344-1815
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SY
Authorized Official First Name:
REINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
323-459-2264

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 46995 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5616858 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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