Healthcare Provider Details

I. General information

NPI: 1811794613
Provider Name (Legal Business Name): ST. JOHN'S COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N WATERMAN AVE
SAN BERNARDINO CA
92404-5111
US

IV. Provider business mailing address

808 W 58TH ST
LOS ANGELES CA
90037-3632
US

V. Phone/Fax

Practice location:
  • Phone: 213-226-7396
  • Fax: 323-541-1445
Mailing address:
  • Phone: 213-226-7396
  • Fax: 323-541-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PETER TAWFIK
Title or Position: CHIEF PHARMACY OFFICER
Credential:
Phone: 615-957-8115