=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528865326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. JOHN'S COMMUNITY HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2025
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 82025 US HIGHWAY 111
-----------------------------------------------------
City | INDIO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92201-5686
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-226-7396
-----------------------------------------------------
Fax | 888-385-2660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 808 W 58TH ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90037-3632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-226-7396
-----------------------------------------------------
Fax | 323-541-1445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF PHARMACY OFFICER
-----------------------------------------------------
Name | PETER TAWFIK
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 615-957-8115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------