Provider Demographics
NPI:1508943473
Name:GUADALUPE PHARMACY INC
Entity Type:Organization
Organization Name:GUADALUPE PHARMACY INC
Other - Org Name:SANTA MARIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:562-630-1620
Mailing Address - Street 1:16444 PARAMOUNT BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5422
Mailing Address - Country:US
Mailing Address - Phone:562-790-8618
Mailing Address - Fax:562-790-8888
Practice Address - Street 1:16444 PARAMOUNT BLVD
Practice Address - Street 2:STE 105
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5422
Practice Address - Country:US
Practice Address - Phone:562-790-8618
Practice Address - Fax:562-790-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA517203336C0003X
CAPHY420823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144092OtherPK
CAPHA420820Medicaid