Provider Demographics
NPI:1033107438
Name:B & B PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:B & B PHARMACY SERVICES LLC
Other - Org Name:COFFEE PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-522-3367
Mailing Address - Street 1:2020 COFFEE RD
Mailing Address - Street 2:STE C2
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2427
Mailing Address - Country:US
Mailing Address - Phone:209-522-3367
Mailing Address - Fax:209-522-3375
Practice Address - Street 1:2020 COFFEE RD
Practice Address - Street 2:STE C2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2427
Practice Address - Country:US
Practice Address - Phone:209-522-3367
Practice Address - Fax:209-522-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0530976OtherNABP OR NCPDP
0530976OtherNABP OR NCPDP
CA1090320001Medicare ID - Type Unspecified