Provider Demographics
NPI:1932332343
Name:REZCARE PHARMACY INC.
Entity Type:Organization
Organization Name:REZCARE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:619-878-6188
Mailing Address - Street 1:3821 CALLE FORTUNADA STE D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4811
Mailing Address - Country:US
Mailing Address - Phone:619-878-6188
Mailing Address - Fax:619-795-0716
Practice Address - Street 1:3821 CALLE FORTUNADA STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4811
Practice Address - Country:US
Practice Address - Phone:619-878-6188
Practice Address - Fax:619-795-0716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5635707OtherNCPDP
CAPHY50158Medicaid
CA5635707OtherNCPDP