MEDICARE: K C B PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist
2	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1679114896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K C B PHARMACY INC

Provider Business Mailing Address
First Line	:	3500 S BRISTOL ST STE 102
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-7319
Country	:	US
Telephone Number	:	714-755-7002
Fax Number	:	714-755-7613

Provider Business Practice Location Address
First Line	:	3500 S BRISTOL ST STE 102
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-7319
Country	:	US
Telephone Number	:	714-755-7002
Fax Number	:	714-755-7613

Authorized Official
Title or Position	:	PIC/CEO
Name	:	ANIL BHALODIA
Credential	:	RPH
Telephone Number	:	714-755-7002

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	03/27/2026

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