Healthcare Provider Details

I. General information

NPI: 1679914014
Provider Name (Legal Business Name): RHEEM SPECIALTY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 RHEEM BLVD STE 109
MORAGA CA
94556-1511
US

IV. Provider business mailing address

346 RHEEM BLVD STE 109
MORAGA CA
94556-1511
US

V. Phone/Fax

Practice location:
  • Phone: 877-404-7112
  • Fax: 925-388-0741
Mailing address:
  • Phone: 877-404-7112
  • Fax: 925-388-0741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number51285
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number51285
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number51285
License Number StateCA

VIII. Authorized Official

Name: JEFF MORGRIDGE
Title or Position: OWNER/ MANAGING PARTNER
Credential:
Phone: 877-404-7112