Healthcare Provider Details

I. General information

NPI: 1922653427
Provider Name (Legal Business Name): ST CYRIL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32241 CAMINO CAPISTRANO STE A104
SAN JUAN CAPISTRANO CA
92675-3708
US

IV. Provider business mailing address

32241 CAMINO CAPISTRANO STE A104
SAN JUAN CAPISTRANO CA
92675-3708
US

V. Phone/Fax

Practice location:
  • Phone: 949-484-8433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GENEVIEVE BENJAMIN
Title or Position: CEO
Credential:
Phone: 949-293-9857