Healthcare Provider Details

I. General information

NPI: 1174906895
Provider Name (Legal Business Name): SNP PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W GARVEY AVE S STE 200&300
WEST COVINA CA
91790-2656
US

IV. Provider business mailing address

900 WESTERN AVE
GLENDALE CA
91201-2353
US

V. Phone/Fax

Practice location:
  • Phone: 833-353-8273
  • Fax: 844-484-4463
Mailing address:
  • Phone: 833-353-8273
  • Fax: 844-484-4463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY51882
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

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