Healthcare Provider Details

I. General information

NPI: 1295869733
Provider Name (Legal Business Name): KBC PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 FOREST SHADE RD STE 7
CRESTLINE CA
92325-9274
US

IV. Provider business mailing address

580 FOREST SHADE RD PO BOX 2220 STE 7
CRESTLINE CA
92325-2220
US

V. Phone/Fax

Practice location:
  • Phone: 909-338-1875
  • Fax: 909-338-1876
Mailing address:
  • Phone: 909-338-1875
  • Fax: 909-338-1876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE PATEL
Title or Position: CEO
Credential: PHARM.D.
Phone: 909-338-1875