Provider Demographics
NPI:1548966518
Name:DIB PHARMACEUTICAL INC
Entity type:Organization
Organization Name:DIB PHARMACEUTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-605-0000
Mailing Address - Street 1:528 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4008
Mailing Address - Country:US
Mailing Address - Phone:619-605-0000
Mailing Address - Fax:619-558-3500
Practice Address - Street 1:528 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4008
Practice Address - Country:US
Practice Address - Phone:619-605-0000
Practice Address - Fax:619-558-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821619271Medicaid