Provider Demographics
NPI:1689047284
Name:K C B PHARMACY INC
Entity Type:Organization
Organization Name:K C B PHARMACY INC
Other - Org Name:SOUTH COAST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BHALODIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-755-7002
Mailing Address - Street 1:3378 S BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-8203
Mailing Address - Country:US
Mailing Address - Phone:714-755-7002
Mailing Address - Fax:714-755-7613
Practice Address - Street 1:3378 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-8203
Practice Address - Country:US
Practice Address - Phone:714-755-7002
Practice Address - Fax:714-755-7613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538733336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689047284Medicaid