KBC Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · Crestline, CA
NPI 1295869733 · NPPES record last updated Jun 18, 2026
Key facts
- NPI
- 1295869733
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- KBC PHARMACY INC
- Practice address
- 24057 Lake Drive
Ste 1 PO Box 2220
Crestline, CA 92325-2220 - Phone
- (909) 338-1875
- Fax
- (909) 338-1876
- NPI assigned
- Mar 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Christine Patel
- Title
- VP
- Phone
- (909) 338-1875
Practitioners 2
-
Christine Patel, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240826002295 | CA | DME Supplier - Pharmacy | 2365981032 | Practice locations: Crestline, CA |
| O20240828001737 | CA | Part B Supplier - Mass Immunization (Roster Biller Only) | 2365981032 | Practice locations: Crestline, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
24057 Lake Drive
Ste 1 PO Box 2220
Crestline, CA 92325-2220
Mailing address
2476 Huntington Dr
San Marino, CA 91108-2643
Phone (888) 986-7666
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295869733 | Medicaid | CA |
Other names
- 986 Pharmacy #8024
Other providers in Crestline, CA
- Gwenda Ann Humpherys
- Misty Rhiannon Hutton
- International Physicians Management Services
- Mary Victoria Jetmore-Reichardt
- Jennifer Paulene Jones
- Lauren Wallace Keaney
- Alysha Taylor Kerr
- Dee Dee King
- Patricia Lynn Liles
- Hannah Littrell
All providers in Crestline, CA · Community/Retail Pharmacy in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.