St Kerollos Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · Cudahy, CA
NPI 1992716583 · NPPES record last updated Mar 24, 2017
Key facts
- NPI
- 1992716583
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHY54607 (CA)
- Legal business name
- ST KEROLLOS PHARMACY INC
- Practice address
- 4566 Florence Ave
Ste 9
Cudahy, CA 90201-4345 - Phone
- (323) 562-1577
- Fax
- (323) 733-5140
- NPI assigned
- Aug 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Bassem Henein
- Title
- Ceo
- Phone
- (323) 562-1578
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility Supplies (DME) | 332BN1400X | |||
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHY54607 | CA | Yes |
| Long Term Care Pharmacy | 3336L0003X | |||
| Specialty Pharmacy | 3336S0011X |
Addresses
Primary practice location
4566 Florence Ave
Ste 9
Cudahy, CA 90201-4345
Mailing address
4566 Florence Ave
Ste 9
Cudahy, CA 90201-4345
Phone (323) 562-1577
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992716583 | Medicaid | CA | |
| 2166511 | Other | PK |
Other names
- JUELLE AND LIMA PHARMACY
Other providers in Cudahy, CA
- Elizabeth Solorzano
- Dayanna Elizabeth Soto
- South Central Family Health Center
- South Central Family Health Center
- Special Care 4 Special Smiles
- T & T Care Inc
- Elizabeth A Tanton
- Ashley Ann Tavara
- Jorge Alberto Tello Motta
- Chynara Tobay
All providers in Cudahy, CA · Community/Retail Pharmacy in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.