Organization
ST KEROLLOS PHARMACY INC
Active
Other names
Carson Discount Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BASSEM NABIL HABIB HENEIN (OWNER)
(562) 480-8254
Entity
Organization
Contact information
Practice address
111 E CARSON ST STE B, CARSON, CA 90745-7722
(310) 835-1000
(310) 835-3000
Mailing address
4566 FLORENCE AVE STE 4, BELL, CA 90201-4346
(323) 562-1651
(323) 562-1651
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY55991
CA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306344858
—
CA
01
—
7591770003
MEDICARE DME PTAN
—
01
—
CB303409
MEDICARE MASS IMMUNIZATION ROSTER BILL PTAN
—
Enumeration date
01/30/2018
Last updated
04/10/2026
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