Healthcare Provider Details

I. General information

NPI: 1033046602
Provider Name (Legal Business Name): REID KODANI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 C ST STE 100
SAN DIEGO CA
92101-4809
US

IV. Provider business mailing address

333 C ST STE 100
SAN DIEGO CA
92101-4809
US

V. Phone/Fax

Practice location:
  • Phone: 619-232-8101
  • Fax: 619-232-8855
Mailing address:
  • Phone: 619-232-8101
  • Fax: 619-232-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: