Provider Demographics
NPI:1144245929
Name:THE PRESCRIPTION SHOPPE
Entity Type:Organization
Organization Name:THE PRESCRIPTION SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PART-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHER
Authorized Official - Middle Name:GUIRGUIS
Authorized Official - Last Name:GUINDI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:760-256-5614
Mailing Address - Street 1:400 S 2ND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2805
Mailing Address - Country:US
Mailing Address - Phone:760-256-5614
Mailing Address - Fax:760-256-4461
Practice Address - Street 1:400 S 2ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2805
Practice Address - Country:US
Practice Address - Phone:760-256-5614
Practice Address - Fax:760-256-4461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 45493183500000X
CAPHA 47900183500000X
CAPHA 35577183500000X
CAPHA 35592183500000X
CATCH 20170183700000X
CATCH 26981183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Not Answered183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA454930Medicaid
CA0586783Medicare UPIN
CA4362420001Medicare NSC