Provider Demographics
NPI:1477250520
Name:YOUR PHARMACY, LLC
Entity Type:Organization
Organization Name:YOUR PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:IMADEDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAZE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:951-845-8252
Mailing Address - Street 1:835 HIGHLAND SPRINGS AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-5771
Mailing Address - Country:US
Mailing Address - Phone:951-845-8252
Mailing Address - Fax:951-845-6525
Practice Address - Street 1:835 HIGHLAND SPRINGS AVE STE 110
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-5771
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:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy