Provider Demographics
NPI:1639358047
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:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-848-8112
Mailing Address - Street 1:212 WEST MAGNOLIA BLVD.
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1724
Mailing Address - Country:US
Mailing Address - Phone:818-848-8112
Mailing Address - Fax:818-848-8142
Practice Address - Street 1:212 W MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1724
Practice Address - Country:US
Practice Address - Phone:818-848-8112
Practice Address - Fax:818-848-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336S0011X, 3336S0011X
NVPH028223336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000189056Medicaid
CAPHY58715OtherCALIFORNIA BOARD OF PHARMACY
2116549OtherPK
CA1639358047Medicaid