Provider Demographics
NPI:1518058791
Name:PAPAGEORGE ENTERPRISES INC
Entity Type:Organization
Organization Name:PAPAGEORGE ENTERPRISES INC
Other - Org Name:NIPOMO REXALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAPAGEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-929-1929
Mailing Address - Street 1:330 W TEFFT ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-8876
Mailing Address - Country:US
Mailing Address - Phone:805-929-1929
Mailing Address - Fax:805-929-2041
Practice Address - Street 1:330 W TEFFT ST
Practice Address - Street 2:SUITE E
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-8876
Practice Address - Country:US
Practice Address - Phone:805-929-1929
Practice Address - Fax:805-929-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY36873333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA332130Medicaid
CA0295420001Medicare NSC