Provider Demographics
NPI:1164690657
Name:NB HEALTHCARE, LLC
Entity Type:Organization
Organization Name:NB HEALTHCARE, LLC
Other - Org Name:VAIL RANCH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NILESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VAGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-303-8300
Mailing Address - Street 1:32675 TEMECULA PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6913
Mailing Address - Country:US
Mailing Address - Phone:951-303-8300
Mailing Address - Fax:951-303-8322
Practice Address - Street 1:32675 TEMECULA PKWY
Practice Address - Street 2:STE B
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6917
Practice Address - Country:US
Practice Address - Phone:951-303-8300
Practice Address - Fax:951-303-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 333600000X
CAPHY489273336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164690657Medicaid
CA1164690657Medicaid