Provider Demographics
NPI:1336125236
Name:SABRINA ENTERPRISES, INC.
Entity Type:Organization
Organization Name:SABRINA ENTERPRISES, INC.
Other - Org Name:DWAYNES FRIENDLY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:NORTON
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:760-872-2497
Mailing Address - Street 1:644 W LINE ST
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-3315
Mailing Address - Country:US
Mailing Address - Phone:760-872-2497
Mailing Address - Fax:760-872-3935
Practice Address - Street 1:644 W LINE ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3315
Practice Address - Country:US
Practice Address - Phone:760-872-2497
Practice Address - Fax:760-872-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA35213333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0589777OtherNCPDP NUMBER
CAFLU11421FOtherFLU PROVIDER #
CAPHA352130Medicaid
CAPHA352130Medicaid
0589777OtherNCPDP NUMBER