Shawki Bachoua

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY43632 Issued in CA

Legal business name

SHAWKI BACHOUA

Doing business as

South Bay Drugs

Practice address

779 Palm Ave
Imperial Beach, CA 91932-1234

Phone

(619) 424-5164

Fax

(619) 423-8492

NPI assigned

Aug 10, 2006

Last updated

Dec 10, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shawki Bachoua

Title

Owner

Phone

(619) 424-5559

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• SOUTH BAY DRUGS Doing business as

Locations

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260403200000",
    "number": "1417968090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "779 PALM AVE",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "919321234",
            "telephone_number": "619-424-5164",
            "fax_number": "619-423-8492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "779 PALM AVE",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "919321234",
            "telephone_number": "619-424-5164",
            "fax_number": "619-423-8492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWKI BACHOUA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2009-12-10",
        "status": "A",
        "authorized_official_last_name": "BACHOUA",
        "authorized_official_first_name": "SHAWKI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-424-5559"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY43632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0534001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA436320",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH BAY DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Annie E Scott, R.D.
• Seacoast Behavior, LLC
• Kathleen Erin Shearman, LIMHP, LPCC
• Jesus Miguel Silva, ATC
• Solara Medical Supplies, LLC (Imperial Beach Pharmacy)
• South Bay Union School District
• Bonnie Lynne Spector, OD

• Community/Retail Pharmacy in Imperial Beach, CA
• Providers in Imperial Beach, 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 Dec 10, 2009; 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.