Healthcare Provider Details

I. General information

NPI: 1316963952
Provider Name (Legal Business Name): SAN MARCOS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16279 PARAMOUNT BLVD STE G
PARAMOUNT CA
90723-5421
US

IV. Provider business mailing address

16279 PARAMOUNT BLVD UNIT G
PARAMOUNT CA
90723-5421
US

V. Phone/Fax

Practice location:
  • Phone: 562-630-1620
  • Fax: 562-630-1720
Mailing address:
  • Phone: 562-630-1620
  • Fax: 562-630-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY53623
License Number StateCA

VIII. Authorized Official

Name: MICHAEL SOLIMAN
Title or Position: OWNER
Credential: RPH
Phone: 562-630-1620