Portola Village Pharmacy

LBN: Kibble Enterprises, Inc.
Portola Village Pharmacy is an health care organization with primary practice located at 157 Commercial St , Portola CA 96122-9606. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Mail Order Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Kibble Enterprises, Inc. can be contacted via phone (530) 832-4218, or through Kibble, Karen M via phone (530) 277-2107.

Contact Information

Primary practice address
157 Commercial St Portola CA 96122-9606
Phone: (530) 832-4218
Fax: (530) 832-1375
Website:
Map and Directions
Authorized official contact:
Name: Kibble, Karen M
Phone: (530) 277-2107

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X California
Suppliers / Mail Order Pharmacy 3336M0002X

Profile Details

NPI number 1679666002
LBN Legal business name Kibble Enterprises, Inc.
DBA Doing business as Portola Village Pharmacy
Authorized official Kibble, Karen M
Entity Organization
Organization subpart 1 No
Enumeration date Sep 30th, 2006
Last updated Jun 12th, 2021 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679666002 NPPES
Other 0541183 NCPDP PROVIDER IDENTIFICATION NUMBER
MEDICAID PHA50236 NCPDP PROVIDER IDENTIFICATION NUMBER

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