Healthcare Provider Details

I. General information

NPI: 1295789048
Provider Name (Legal Business Name): FISHBOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8704 SEPULVEDA BLVD
NORTH HILLS CA
91343-5112
US

IV. Provider business mailing address

8704 SEPULVEDA BLVD
NORTH HILLS CA
91343-5112
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-3333
  • Fax: 818-894-3301
Mailing address:
  • Phone: 818-894-3333
  • Fax: 818-894-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY49969
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY 49969
License Number StateCA

VIII. Authorized Official

Name: DR. MARIA KILIMNIK
Title or Position: PRESIDENT/PIC
Credential: PHARM D
Phone: 818-894-3333