Provider Demographics
NPI:1174906895
Name:SNP PHARMACY LLC
Entity type:Organization
Organization Name:SNP PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-820-5810
Mailing Address - Street 1:900 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2353
Mailing Address - Country:US
Mailing Address - Phone:833-353-8273
Mailing Address - Fax:844-484-4463
Practice Address - Street 1:900 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2353
Practice Address - Country:US
Practice Address - Phone:818-658-5705
Practice Address - Fax:818-658-5712
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKILLED NURSING PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-30
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY518823336L0003X
3336S0011X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY51882OtherBOARD OF PHARMACY