Provider Demographics
NPI:1104191592
Name:PGBB LLC
Entity Type:Organization
Organization Name:PGBB LLC
Other - Org Name:SPECIALTY CARE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-941-6177
Mailing Address - Street 1:200 E KATELLA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-4805
Mailing Address - Country:US
Mailing Address - Phone:714-941-6177
Mailing Address - Fax:714-941-6178
Practice Address - Street 1:200 E KATELLA AVE STE A
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-4805
Practice Address - Country:US
Practice Address - Phone:714-941-6177
Practice Address - Fax:714-941-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY59102OtherBOARD OF PHARMACY
5643184OtherNCPDP PROVIDER IDENTIFICATION NUMBER