Healthcare Provider Details

I. General information

NPI: 1962514950
Provider Name (Legal Business Name): JOHN N DABBS III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2067 W VISTA WAY STE195
VISTA CA
92083-6031
US

IV. Provider business mailing address

2067 W VISTA WAY STE195
VISTA CA
92083-6031
US

V. Phone/Fax

Practice location:
  • Phone: 760-631-1010
  • Fax: 760-758-7612
Mailing address:
  • Phone: 760-631-1010
  • Fax: 760-758-7612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY37480
License Number StateCA

VIII. Authorized Official

Name: JOHN DABBS
Title or Position: OWNER
Credential:
Phone: 760-631-1010