Provider Demographics
NPI:1972524932
Name:SIX DEGREES, INC.
Entity type:Organization
Organization Name:SIX DEGREES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-744-9397
Mailing Address - Street 1:15247 11TH ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3727
Mailing Address - Country:US
Mailing Address - Phone:760-245-7761
Mailing Address - Fax:760-245-8303
Practice Address - Street 1:15247 11TH ST.
Practice Address - Street 2:1000A & 1000B
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3727
Practice Address - Country:US
Practice Address - Phone:760-245-7761
Practice Address - Fax:760-245-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1998716OtherPK
CAPHA311060Medicaid
0565537OtherOTHER ID NUMBER-COMMERCIAL NUMBER