1295869733 NPI number — KBC PHARMACY INC

Table of content: (NPI 1295869733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295869733 NPI number — KBC PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KBC PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295869733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2476 HUNTINGTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MARINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91108-2643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-986-7666
Provider Business Mailing Address Fax Number:
626-399-0421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24057 LAKE DRIVE
Provider Second Line Business Practice Location Address:
STE 1 PO BOX 2220
Provider Business Practice Location Address City Name:
CRESTLINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92325-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-338-1875
Provider Business Practice Location Address Fax Number:
909-338-1876
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
909-338-1875

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1295869733 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com