St Kerollos Pharmacy Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

PHY54606 Issued in CA

Legal business name

ST KEROLLOS PHARMACY INC

Doing business as

American Home Pharmacy

Practice address

4566 Florence Ave
Ste 4
Bell, CA 90201-4345

Phone

(323) 562-1578

Fax

(323) 562-1651

NPI assigned

Jan 2, 2008

Last updated

Apr 5, 2017By 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

Bassem Henein

Title

Ceo

Phone

(323) 562-1577

Specialties & licenses 6

Addresses

Other identifiers 1

Other names 1

• American Home Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491350400000",
    "number": "1922283621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4566 FLORENCE AVE",
            "address_2": "STE 4",
            "city": "BELL",
            "state": "CA",
            "postal_code": "902014345",
            "telephone_number": "323-562-1578",
            "fax_number": "323-562-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4566 FLORENCE AVE",
            "address_2": "STE 4",
            "city": "BELL",
            "state": "CA",
            "postal_code": "902014345",
            "telephone_number": "323-562-1578",
            "fax_number": "323-562-1651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST KEROLLOS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-02",
        "last_updated": "2017-04-05",
        "status": "A",
        "authorized_official_last_name": "HENEIN",
        "authorized_official_first_name": "BASSEM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-562-1577"
    },
    "taxonomies": [
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CA",
            "license": "PHY54606",
            "primary": true
        },
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2166189",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "American Home Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in Bell, CA
• Providers in Bell, CA by specialty
• Long Term Care Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.