Healthcare Provider Details

I. General information

NPI: 1073671293
Provider Name (Legal Business Name): PHARMBLUE CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MAIN ST
POINT ARENA CA
95468
US

IV. Provider business mailing address

PO BOX 133
POINT ARENA CA
95468-0133
US

V. Phone/Fax

Practice location:
  • Phone: 707-882-3025
  • Fax: 707-882-3084
Mailing address:
  • Phone: 724-779-4720
  • Fax: 724-779-4721

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 Number53368
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH POHL
Title or Position: CEO/AO
Credential:
Phone: 724-779-4720