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General NPI Number Information
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NPI Number | 1972524932
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Entity Type | Organization
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Legal Business Name | SIX DEGREES, INC.
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 15247 11TH ST. 1000A & 1000B
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City | VICTORVILLE
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State | CA
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Zip | 92395-3727
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Country | US
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Telephone | 760-245-7761
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Fax | 760-245-8303
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Provider Business Mailing Address
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Address Line | 15247 11TH ST
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City | VICTORVILLE
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State | CA
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Zip | 92395-3727
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Country | US
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Telephone | 760-245-7761
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Fax | 760-245-8303
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Authorized Official
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Title or Position | CEO
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Name | MARIANNE ANTONIO
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Credential |
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Telephone | 954-744-9397
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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