Provider Demographics
NPI:1689789315
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:BUSS. OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-820-5800
Mailing Address - Street 1:16666 E JOHNSON DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91745-2412
Mailing Address - Country:US
Mailing Address - Phone:626-820-5814
Mailing Address - Fax:626-820-5815
Practice Address - Street 1:16666 E JOHNSON DR
Practice Address - Street 2:SUITE C
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91745-2412
Practice Address - Country:US
Practice Address - Phone:626-820-5814
Practice Address - Fax:626-820-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY499723336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA454690Medicaid
CAPHA454690Medicaid