Organization Name: | KBM ENTERPRISES, INC |
NPI Number: | 1700188505 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHAD KEARNS (PRESIDENT) |
Mailing Address: | 2700 E Coast Hwy Corona Del Mar |
State: | CA US |
Postal Code: | 926252128 |
Phone Number: | 9496447575 |
Fax Number: | 9496442340 |
NPI Enumeration Date: | 11/30/2010 |
NPI Last Update Date: | 11/30/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | PHY 50412 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Compounding Pharmacy |
Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |