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General NPI Number Information
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NPI Number | 1942282884
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Entity Type | Organization
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Legal Business Name | SUPER CARE DRUGS INC
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 23357 PACIFIC COAST HWY
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City | MALIBU
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State | CA
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Zip | 90265-4957
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Country | US
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Telephone | 310-456-9059
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Fax | 310-456-6529
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Provider Business Mailing Address
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Address Line | 23661 PACIFIC COAST HWY
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City | MALIBU
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State | CA
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Zip | 90265-4825
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Country | US
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Telephone | 310-456-1177
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Fax | 310-456-6529
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Authorized Official
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Title or Position | PHARMACIST
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Name | THOMAS S PARK
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Credential | RPH
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Telephone | 310-456-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY46214
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License Number State | CA
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