Healthcare Provider Details

I. General information

NPI: 1922283621
Provider Name (Legal Business Name): ST KEROLLOS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4566 FLORENCE AVE STE 4
BELL CA
90201-4345
US

IV. Provider business mailing address

4566 FLORENCE AVE STE 4
BELL CA
90201-4345
US

V. Phone/Fax

Practice location:
  • Phone: 323-562-1578
  • Fax: 323-562-1651
Mailing address:
  • Phone: 323-562-1578
  • Fax: 323-562-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY54606
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BASSEM HENEIN
Title or Position: CEO
Credential:
Phone: 323-562-1577