Healthcare Provider Details

I. General information

NPI: 1205008299
Provider Name (Legal Business Name): SNP PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 SCRIPPS LAKE DR STE 108
SAN DIEGO CA
92131-1080
US

IV. Provider business mailing address

9920 SCRIPPS LAKE DR STE 108
SAN DIEGO CA
92131-1080
US

V. Phone/Fax

Practice location:
  • Phone: 858-564-2000
  • Fax: 585-564-2100
Mailing address:
  • Phone: 858-564-2000
  • Fax: 585-564-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY49973
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: RUBY BAYLIN
Title or Position: MANAGER
Credential:
Phone: 626-820-5810