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General NPI Number Information
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NPI Number | 1750529038
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Entity Type | Organization
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Legal Business Name | SIMONS DISCOUNT PHARMACY INC
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 111 E CARSON ST STE B
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City | CARSON
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State | CA
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Zip | 90745-2731
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Country | US
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Telephone | 310-518-0020
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Fax | 310-518-0025
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Provider Business Mailing Address
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Address Line | 111 E CARSON ST STE B
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City | CARSON
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State | CA
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Zip | 90745-2731
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Country | US
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Telephone | 310-518-0020
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Fax | 310-518-0025
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Authorized Official
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Title or Position | OWNER,PIC,AO
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Name | MARY IBRAHIM
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Credential | RPH
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Telephone | 310-518-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY49812
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License Number State | CA
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