Healthcare Provider Details

I. General information

NPI: 1851463657
Provider Name (Legal Business Name): RELIANCE CASTLE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 HOSPITAL ROAD SUITE D
ATWATER CA
95301-5173
US

IV. Provider business mailing address

3605 HOSPITAL ROAD SUITE D
ATWATER CA
95301-5173
US

V. Phone/Fax

Practice location:
  • Phone: 209-723-1888
  • Fax: 209-723-1858
Mailing address:
  • Phone: 209-723-1888
  • Fax: 209-723-1858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 50666
License Number StateCA

VIII. Authorized Official

Name: MS. NEELMIA VANGA
Title or Position: MEMBER/MANAGER
Credential:
Phone: 209-723-1888