Organization
KIBBLE ENTERPRISES, INC.
Active
Other names
PORTOLA VILLAGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN M KIBBLE (SECRETARY)
(530) 277-2107
Entity
Organization
Contact information
Practice address
157 COMMERCIAL ST, PORTOLA, CA 96122-9606
(530) 832-4218
(530) 832-1375
Mailing address
PO BOX 1918, PORTOLA, CA 96122-1918
(530) 277-2107
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
CA
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0541183
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA50236
—
CA
Enumeration date
09/30/2006
Last updated
06/12/2021
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