=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508256256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. LUKE PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2015
-----------------------------------------------------
Last Update Date | 02/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16317 CLARK AVE
-----------------------------------------------------
City | BELLFLOWER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90706-5209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-202-9838
-----------------------------------------------------
Fax | 562-202-9839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16317 CLARK AVE
-----------------------------------------------------
City | BELLFLOWER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90706-5209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-202-9838
-----------------------------------------------------
Fax | 562-202-9839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. SHUKRI F SALIBA
-----------------------------------------------------
Credential | PHARM.D
-----------------------------------------------------
Telephone | 562-220-2630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PHY 52035
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------