Organization
ST KEROLLOS PHARMACY INC
Active
Other names
JUELLE AND LIMA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BASSEM HENEIN (CEO)
(323) 562-1578
Entity
Organization
Contact information
Practice address
4566 FLORENCE AVE, STE 9, CUDAHY, CA 90201-4345
(323) 562-1577
(323) 733-5140
Mailing address
4566 FLORENCE AVE, STE 9, CUDAHY, CA 90201-4345
(323) 562-1577
(323) 733-5140
Taxonomy
Speciality
Code
Description
License number
State
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY54607
CA
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992716583
—
CA
01
—
2166511
PK
—
Enumeration date
08/10/2006
Last updated
03/24/2017
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