Provider Demographics
NPI:1295789048
Name:FISHBOR INC
Entity type:Organization
Organization Name:FISHBOR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KILIMNIK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-894-3333
Mailing Address - Street 1:8704 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-5112
Mailing Address - Country:US
Mailing Address - Phone:818-894-3333
Mailing Address - Fax:818-894-3301
Practice Address - Street 1:8704 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5112
Practice Address - Country:US
Practice Address - Phone:818-894-3333
Practice Address - Fax:818-894-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 499693336L0003X
CAPHY499693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0593411OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0593411OtherNCPDP PROVIDER IDENTIFICATION NUMBER