Healthcare Provider Details

I. General information

NPI: 1689047284
Provider Name (Legal Business Name): K C B PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 S BRISTOL ST STE 102
SANTA ANA CA
92704-7319
US

IV. Provider business mailing address

3500 S BRISTOL ST STE 102
SANTA ANA CA
92704-7319
US

V. Phone/Fax

Practice location:
  • Phone: 714-755-7002
  • Fax: 714-755-7613
Mailing address:
  • Phone: 714-755-7002
  • Fax: 714-755-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number53873
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANIL C BHALODIA
Title or Position: PIC/OWNER
Credential: RPH
Phone: 714-755-7002