=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306526611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBEKAH ANNE FACCINTO PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2023
-----------------------------------------------------
Last Update Date | 07/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1815 HERNDON AVE
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93611-6109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-325-1324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10223 N PRICE AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93730-5104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-269-4475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 88108
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------