Provider Demographics
NPI:1205008299
Name:SNP PHARMACY LLC
Entity Type:Organization
Organization Name:SNP PHARMACY LLC
Other - Org Name:SKILLED NURSING PHARMACY
Other - Org Type:Doing Business As
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 1:9920 SCRIPPS LAKE DR
Mailing Address - Street 2:STE 108
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1080
Mailing Address - Country:US
Mailing Address - Phone:858-564-2000
Mailing Address - Fax:585-564-2100
Practice Address - Street 1:9920 SCRIPPS LAKE DR
Practice Address - Street 2:STE 108
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1080
Practice Address - Country:US
Practice Address - Phone:858-564-2000
Practice Address - Fax:585-564-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X
CAPHY499733336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5629665OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA499730Medicaid