Provider Demographics
NPI:1306526611
Name:FACCINTO, REBEKAH ANNE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:ANNE
Last Name:FACCINTO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10223 N PRICE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-5104
Mailing Address - Country:US
Mailing Address - Phone:559-269-4475
Mailing Address - Fax:
Practice Address - Street 1:1815 HERNDON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6109
Practice Address - Country:US
Practice Address - Phone:559-325-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88108333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy