Organization
ST KEROLLOS PHARMACY INC
Active
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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