Provider Demographics
NPI:1508114869
Name:SORIANO, REGINALD MARK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:MARK
Last Name:SORIANO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 CANYON SPRINGS PKWY
Mailing Address - Street 2:T-1843
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0932
Mailing Address - Country:US
Mailing Address - Phone:951-697-6449
Mailing Address - Fax:951-571-8710
Practice Address - Street 1:2755 CANYON SPRINGS PKWY
Practice Address - Street 2:T-1843
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0932
Practice Address - Country:US
Practice Address - Phone:951-697-6449
Practice Address - Fax:951-571-8710
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist