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General NPI Number Information
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NPI Number | 1669264388
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Entity Type | Organization
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Legal Business Name | KABAFUSION GA, LLC
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 2140 NEWMARKET PKWY SE STE 106
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City | MARIETTA
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State | GA
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Zip | 30067-8766
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Country | US
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Telephone | 888-211-8316
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Fax | 706-725-8194
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Provider Business Mailing Address
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Address Line | 17777 CENTER COURT DR N STE 550
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City | CERRITOS
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State | CA
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Zip | 90703-9337
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Country | US
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Telephone | 800-435-3020
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DR. TINA BENKENDORFER
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Credential | PHARM. D.
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Telephone | 800-435-3020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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