Kibble Enterprises, Inc.
Organization Active NPI Community/Retail Pharmacy · Portola, CA
NPI 1679666002 · NPPES record last updated Jun 12, 2021
Key facts
- NPI
- 1679666002
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- KIBBLE ENTERPRISES, INC.
- Practice address
- 157 Commercial St
Portola, CA 96122-9606 - Phone
- (530) 832-4218
- Fax
- (530) 832-1375
- NPI assigned
- Sep 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Karen M Kibble
- Title
- Secretary
- Phone
- (530) 277-2107
Practitioners 2
-
Michael William Kibble, PHARM D
-
Mary Therese Pearson, R. PH
National Provider Directory
Locations
493 Main St
Quincy, CA 95971
Phone (530) 283-0480
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | CA | Yes | |
| Mail Order Pharmacy | 3336M0002X |
Addresses
Primary practice location
157 Commercial St
Portola, CA 96122-9606
Mailing address
PO Box 1918
Portola, CA 96122-1918
Phone (530) 277-2107
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0541183 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER | |
| PHA50236 | Medicaid | CA |
Other names
- PORTOLA VILLAGE PHARMACY
Other providers in Portola, CA
- Jeanne M. Harper
- Derry L. Hildebrand Jr.
- Richard D Hungerford
- Charles Kaplove
- Jeanne Kessler
- Bruce H Lee
- Sharon Malotte
- Patriot Counseling Services
- Lovsho Phen
- Emilee Ann Pruitt
All providers in Portola, 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 12, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.