Provider Demographics
NPI:1720279169
Name:BBAD ENTERPRISES
Entity Type:Organization
Organization Name:BBAD ENTERPRISES
Other - Org Name:CENTRAL COAST PHARMACY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:FORNEY
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:805-434-5999
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-0280
Mailing Address - Country:US
Mailing Address - Phone:805-434-5999
Mailing Address - Fax:805-434-5968
Practice Address - Street 1:590-A SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-0280
Practice Address - Country:US
Practice Address - Phone:805-434-5999
Practice Address - Fax:805-434-5968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY43878183500000X
CAPHY 438783336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty