# REBEL DISTRIBUTORS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Physician Partner/Pharmacy Partner
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366657488
- **Authorized official:** MR. DESTRY SETSER (CEO/OWNER)
- **Authorized official phone:** (877) 732-3579

## Contact information

- **Practice address:** 3607 OLD CONEJO RD, THOUSAND OAKS, CA 91320-2123
- **Practice address phone:** (805) 214-0900
- **Practice address fax:** (805) 214-0950
- **Mailing address:** 3607 OLD CONEJO RD, THOUSAND OAKS, CA 91320-2123
- **Mailing address phone:** (805) 214-0900
- **Mailing address fax:** (805) 214-0950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | WLS3004 | CA | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | WLS3004 | CA | — |

## Other

- **Enumeration date:** 05/11/2007
- **Last updated:** 02/03/2009