St Kerollos Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY55991 Issued in CA

Legal business name

ST KEROLLOS PHARMACY INC

Practice address

111 E Carson St Ste B
Carson, CA 90745-7722

Phone

(310) 835-1000

Fax

(310) 835-3000

NPI assigned

Jan 30, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bassem Nabil Habib Henein

Title

Owner

Phone

(562) 480-8254

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Carson Discount Pharmacy Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775779200000",
    "number": "1306344858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4566 FLORENCE AVE STE 4",
            "city": "BELL",
            "state": "CA",
            "postal_code": "902014346",
            "telephone_number": "323-562-1651",
            "fax_number": "323-562-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E CARSON ST STE B",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907457722",
            "telephone_number": "310-835-1000",
            "fax_number": "310-835-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST KEROLLOS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-30",
        "last_updated": "2026-04-10",
        "certification_date": "2026-04-10",
        "status": "A",
        "authorized_official_last_name": "HENEIN",
        "authorized_official_first_name": "BASSEM",
        "authorized_official_middle_name": "NABIL HABIB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-480-8254"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY55991",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306344858",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE MASS IMMUNIZATION ROSTER BILL PTAN",
            "identifier": "CB303409",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME PTAN",
            "identifier": "7591770003",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carson Discount Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Carson, CA
• Providers in Carson, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.