Provider Demographics
NPI:1538105515
Name:SIMON'S DISCOUNT PHARMACY, INC.
Entity Type:Organization
Organization Name:SIMON'S DISCOUNT PHARMACY, INC.
Other - Org Name:SIMONS DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ASKANDER
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:323-874-2507
Mailing Address - Street 1:7256 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3410
Mailing Address - Country:US
Mailing Address - Phone:323-874-2507
Mailing Address - Fax:323-874-3508
Practice Address - Street 1:7256 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-3410
Practice Address - Country:US
Practice Address - Phone:323-874-2507
Practice Address - Fax:323-874-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY344683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA344680Medicaid
CAPHA344680Medicaid
CAPHA344680Medicaid