Healthcare Provider Details

I. General information

NPI: 1750529038
Provider Name (Legal Business Name): SIMONS DISCOUNT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E CARSON ST STE B
CARSON CA
90745-2731
US

IV. Provider business mailing address

111 E CARSON ST STE B
CARSON CA
90745-2731
US

V. Phone/Fax

Practice location:
  • Phone: 310-518-0020
  • Fax: 310-518-0025
Mailing address:
  • Phone: 310-518-0020
  • Fax: 310-518-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY49812
License Number StateCA

VIII. Authorized Official

Name: MARY IBRAHIM
Title or Position: OWNER,PIC,AO
Credential: RPH
Phone: 310-518-0020