Healthcare Provider Details

I. General information

NPI: 1427499128
Provider Name (Legal Business Name): RTY PHARMACEUTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5222 BALBOA AVE
SAN DIEGO CA
92117-6904
US

IV. Provider business mailing address

6465 BALBOA AVE STE 101
SAN DIEGO CA
92111-3155
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-0111
  • Fax:
Mailing address:
  • Phone: 858-278-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHY45633
License Number StateCA

VIII. Authorized Official

Name: ROBERT YASMEH
Title or Position: CEO
Credential:
Phone: 858-278-0111