Provider Demographics
NPI:1669019113
Name:SHANZO INC
Entity Type:Organization
Organization Name:SHANZO INC
Other - Org Name:REGENTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-436-5571
Mailing Address - Street 1:PO BOX 504123
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-4123
Mailing Address - Country:US
Mailing Address - Phone:619-436-5571
Mailing Address - Fax:619-436-5572
Practice Address - Street 1:6255 UNIVERSITY AVE STE A1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5727
Practice Address - Country:US
Practice Address - Phone:619-436-5571
Practice Address - Fax:619-436-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy