Healthcare Provider Details

I. General information

NPI: 1265502496
Provider Name (Legal Business Name): ST LUKE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16402 PARAMOUNT BLVD
PARAMOUNT CA
90723-5428
US

IV. Provider business mailing address

16660 PARAMOUNT BLVD STE 106
PARAMOUNT CA
90723-5457
US

V. Phone/Fax

Practice location:
  • Phone: 562-220-2793
  • Fax: 562-220-2753
Mailing address:
  • Phone: 562-220-2630
  • Fax: 562-220-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY44640
License Number StateCA

VIII. Authorized Official

Name: MR. SHUKRI FUAD SALIBA
Title or Position: CEO
Credential: PHARMACIST
Phone: 562-220-2630