Provider Demographics
NPI:1437148400
Name:KOMAKI ENTERPRISES, INC
Entity Type:Organization
Organization Name:KOMAKI ENTERPRISES, INC
Other - Org Name:PILLCO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:SAIJI
Authorized Official - Last Name:KOMAKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:619-561-5602
Mailing Address - Street 1:8575 LOS COCHES RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-8815
Mailing Address - Country:US
Mailing Address - Phone:619-561-5602
Mailing Address - Fax:619-561-5933
Practice Address - Street 1:8575 LOS COCHES RD
Practice Address - Street 2:SUITE 5
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-8815
Practice Address - Country:US
Practice Address - Phone:619-561-5602
Practice Address - Fax:619-561-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY42161332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0597611OtherNCPDP NUMBER
CAPHA421610Medicaid
CAPHY42161OtherSTATE LICENSE NUMBER
CAPHY42161OtherSTATE LICENSE NUMBER
0208080001Medicare ID - Type UnspecifiedPROVIDER NUMBER