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General NPI Number Information
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NPI Number | 1629314869
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Entity Type | Organization
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Legal Business Name | RELIANCE FB RX LLC
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 11333 SEPULVEDA BLVD SUITE 1200
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City | MISSION HILLS
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State | CA
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Zip | 91345-1116
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Country | US
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Telephone | 818-837-5999
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Fax | 818-837-5920
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Provider Business Mailing Address
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Address Line | 11333 SEPULVEDA BLVD SUITE 1200
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City | MISSION HILLS
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State | CA
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Zip | 91345-1116
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Country | US
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Telephone | 818-837-5999
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Fax | 818-837-5920
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | MR. BRAHMAJI VALIVETI
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Credential | RPH
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Telephone | 818-837-5999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY51184
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY51184
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License Number State | CA
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