Healthcare Provider Details

I. General information

NPI: 1518058791
Provider Name (Legal Business Name): PAPAGEORGE ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W TEFFT ST SUITE E
NIPOMO CA
93444-8876
US

IV. Provider business mailing address

330 W TEFFT ST SUITE E
NIPOMO CA
93444-8876
US

V. Phone/Fax

Practice location:
  • Phone: 805-929-1929
  • Fax: 805-929-2041
Mailing address:
  • Phone: 805-929-1929
  • Fax: 805-929-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY36873
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPHA332130
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer

VIII. Authorized Official

Name: MRS. BARBARA R PAPAGEORGE
Title or Position: SECRETARY BOOKKEEPER
Credential:
Phone: 805-929-1929