Provider Demographics
NPI:1508256256
Name:ST. LUKE PHARMACY INC.
Entity Type:Organization
Organization Name:ST. LUKE PHARMACY INC.
Other - Org Name:ST. LUKE PHARMACY #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUKRI
Authorized Official - Middle Name:F
Authorized Official - Last Name:SALIBA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:562-220-2630
Mailing Address - Street 1:16317 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5209
Mailing Address - Country:US
Mailing Address - Phone:562-202-9838
Mailing Address - Fax:562-202-9839
Practice Address - Street 1:16317 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5209
Practice Address - Country:US
Practice Address - Phone:562-202-9838
Practice Address - Fax:562-202-9839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 52035333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 52035OtherCA BOARD OF PHARMACY