# ST KEROLLOS PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** American Home Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922283621
- **Authorized official:** BASSEM HENEIN (CEO)
- **Authorized official phone:** (323) 562-1577

## Contact information

- **Practice address:** 4566 FLORENCE AVE, STE 4, BELL, CA 90201-4345
- **Practice address phone:** (323) 562-1578
- **Practice address fax:** (323) 562-1651
- **Mailing address:** 4566 FLORENCE AVE, STE 4, BELL, CA 90201-4345
- **Mailing address phone:** (323) 562-1578
- **Mailing address fax:** (323) 562-1651

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332BN1400X | Nursing Facility Supplies (DME) | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | PHY54606 | CA | Yes |
| 3336M0003X | Managed Care Organization Pharmacy | — | NULL | — |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 01/02/2008
- **Last updated:** 04/05/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2166189 | PK | — |