Organization
SHAWKI BACHOUA
Active
Other names
SOUTH BAY DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWKI BACHOUA (OWNER)
(619) 424-5559
Entity
Organization
Contact information
Practice address
779 PALM AVE, IMPERIAL BEACH, CA 91932-1234
(619) 424-5164
(619) 423-8492
Mailing address
779 PALM AVE, IMPERIAL BEACH, CA 91932-1234
(619) 424-5164
(619) 423-8492
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY43632
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0534001
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA436320
—
CA
Enumeration date
08/10/2006
Last updated
12/10/2009
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