Provider Demographics
NPI:1073671293
Name:PHARMBLUE CALIFORNIA LLC
Entity Type:Organization
Organization Name:PHARMBLUE CALIFORNIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/AO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:POHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-779-4720
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:POINT ARENA
Mailing Address - State:CA
Mailing Address - Zip Code:95468-0133
Mailing Address - Country:US
Mailing Address - Phone:724-779-4720
Mailing Address - Fax:724-779-4721
Practice Address - Street 1:235 MAIN ST
Practice Address - Street 2:
Practice Address - City:POINT ARENA
Practice Address - State:CA
Practice Address - Zip Code:95468
Practice Address - Country:US
Practice Address - Phone:707-882-3025
Practice Address - Fax:707-882-3084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336S0011X
CA533683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073671293Medicaid
2153548OtherPK