Provider Demographics
NPI:1043607765
Name:YOUR PHARMACY, LLC
Entity Type:Organization
Organization Name:YOUR PHARMACY, LLC
Other - Org Name:BEAUMONT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/ PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:IMADEDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAZE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:708-942-9896
Mailing Address - Street 1:835 N HIGHLAND SPRINGS AVE #110
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223
Mailing Address - Country:US
Mailing Address - Phone:951-845-8252
Mailing Address - Fax:951-845-6525
Practice Address - Street 1:835 N HIGHLAND SPRINGS AVE #110
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223
Practice Address - Country:US
Practice Address - Phone:951-845-8252
Practice Address - Fax:951-845-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043607765Medicaid