Healthcare Provider Details

I. General information

NPI: 1104436542
Provider Name (Legal Business Name): GUADALUPE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16444 PARAMOUNT BLVD STE 101
PARAMOUNT CA
90723-5453
US

IV. Provider business mailing address

16444 PARAMOUNT BLVD STE 101
PARAMOUNT CA
90723-5453
US

V. Phone/Fax

Practice location:
  • Phone: 562-232-3732
  • Fax: 562-232-3651
Mailing address:
  • Phone: 562-232-3732
  • Fax: 562-232-3651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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