MEDICARE: SUPER CARE DRUGS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PHY46214	CA

General Provider Information

NPI Number	:	1942282884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPER CARE DRUGS INC

Provider Business Mailing Address
First Line	:	23661 PACIFIC COAST HWY
Second Line	:
City	:	MALIBU
State	:	CA
Zip	:	90265-4825
Country	:	US
Telephone Number	:	310-456-1177
Fax Number	:	310-456-6529

Provider Business Practice Location Address
First Line	:	23357 PACIFIC COAST HWY
Second Line	:
City	:	MALIBU
State	:	CA
Zip	:	90265-4957
Country	:	US
Telephone Number	:	310-456-9059
Fax Number	:	310-456-6529

Authorized Official
Title or Position	:	PHARMACIST
Name	:	THOMAS S PARK
Credential	:	RPH
Telephone Number	:	310-456-1177

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	10/21/2010

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Directions to “SUPER CARE DRUGS INC ” Practice Location

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