MEDICARE: RELIANCE BEST PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PHY50677	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5634515	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1770718041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIANCE BEST PHARMACY LLC

Provider Business Mailing Address
First Line	:	26930 CHERRY HILLS BLVD
Second Line	:
City	:	SUN CITY
State	:	CA
Zip	:	92586-2574
Country	:	US
Telephone Number	:	951-672-5531
Fax Number	:	951-672-3171

Provider Business Practice Location Address
First Line	:	26930 CHERRY HILLS BLVD
Second Line	:
City	:	SUN CITY
State	:	CA
Zip	:	92586-2574
Country	:	US
Telephone Number	:	951-672-5531
Fax Number	:	951-672-3171

Authorized Official
Title or Position	:	MEMBER
Name	:	BRAHMAJI VALIVETI
Credential	:
Telephone Number	:	951-679-5531

Provider Enumeration Date	:	05/15/2009
Last Update Date	:	01/18/2013

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