Organization
ST KEROLLOS PHARMACY INC
Active
Other names
American Home Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BASSEM HENEIN (CEO)
(323) 562-1577
Entity
Organization
Contact information
Practice address
4566 FLORENCE AVE, STE 4, BELL, CA 90201-4345
(323) 562-1578
(323) 562-1651
Mailing address
4566 FLORENCE AVE, STE 4, BELL, CA 90201-4345
(323) 562-1578
(323) 562-1651
Taxonomy
Speciality
Code
Description
License number
State
332BN1400X
Nursing Facility Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PHY54606
CA
3336M0003X
Managed Care Organization Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166189
PK
—
Enumeration date
01/02/2008
Last updated
04/05/2017
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