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General NPI Number Information
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NPI Number | 1265502496
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Entity Type | Organization
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Legal Business Name | ST LUKE PHARMACY INC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16402 PARAMOUNT BLVD
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City | PARAMOUNT
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State | CA
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Zip | 90723-5428
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Country | US
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Telephone | 562-220-2793
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Fax | 562-220-2753
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Provider Business Mailing Address
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Address Line | 16660 PARAMOUNT BLVD STE 106
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City | PARAMOUNT
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State | CA
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Zip | 90723-5457
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Country | US
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Telephone | 562-220-2630
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Fax | 562-220-2649
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Authorized Official
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Title or Position | CEO
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Name | MR. SHUKRI FUAD SALIBA
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Credential | PHARMACIST
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Telephone | 562-220-2630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHY44640
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License Number State | CA
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