Provider Demographics
NPI:1801015557
Name:REYES, ANGELICA M (PHARMACY TECH)
Entity Type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:M
Last Name:REYES
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2249
Mailing Address - Country:US
Mailing Address - Phone:909-422-0444
Mailing Address - Fax:909-422-0459
Practice Address - Street 1:518 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2249
Practice Address - Country:US
Practice Address - Phone:909-422-0444
Practice Address - Fax:909-422-0459
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64022183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician