Healthcare Provider Details

I. General information

NPI: 1306526611
Provider Name (Legal Business Name): REBEKAH ANNE FACCINTO PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 HERNDON AVE
CLOVIS CA
93611-6109
US

IV. Provider business mailing address

10223 N PRICE AVE
FRESNO CA
93730-5104
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-1324
  • Fax:
Mailing address:
  • Phone: 559-269-4475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number88108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: