Healthcare Provider Details

I. General information

NPI: 1336125236
Provider Name (Legal Business Name): SABRINA ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 W LINE ST
BISHOP CA
93514-3315
US

IV. Provider business mailing address

644 W LINE ST
BISHOP CA
93514-3315
US

V. Phone/Fax

Practice location:
  • Phone: 760-872-2497
  • Fax: 760-872-3935
Mailing address:
  • Phone: 760-872-2497
  • Fax: 760-872-3935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHA35213
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DWAYNE NORTON WILSON
Title or Position: OWNER/MANAGER
Credential: R.PH.
Phone: 760-872-2522