Healthcare Provider Details

I. General information

NPI: 1255438669
Provider Name (Legal Business Name): RENI THOMAS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD # 119
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

4647 ENSENADA DR
WOODLAND HILLS CA
91364-5413
US

V. Phone/Fax

Practice location:
  • Phone: 310-268-3244
  • Fax:
Mailing address:
  • Phone: 818-594-7252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 57271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: