Healthcare Provider Details

I. General information

NPI: 1306344858
Provider Name (Legal Business Name): ST KEROLLOS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E CARSON ST STE B
CARSON CA
90745-7722
US

IV. Provider business mailing address

4566 FLORENCE AVE STE 4
BELL CA
90201-4346
US

V. Phone/Fax

Practice location:
  • Phone: 310-835-1000
  • Fax: 310-835-3000
Mailing address:
  • Phone: 323-562-1651
  • Fax: 323-562-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY55991
License Number StateCA

VIII. Authorized Official

Name: BASSEM NABIL HABIB HENEIN
Title or Position: OWNER
Credential:
Phone: 562-480-8254