Provider Demographics
NPI:1578795803
Name:ST. LUKE PHARMACY, INC.
Entity Type:Organization
Organization Name:ST. LUKE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
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 1:16660 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5433
Mailing Address - Country:US
Mailing Address - Phone:562-220-2630
Mailing Address - Fax:562-220-2649
Practice Address - Street 1:7024 SEVILLE AVE
Practice Address - Street 2:#E
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4969
Practice Address - Country:US
Practice Address - Phone:323-587-1200
Practice Address - Fax:323-587-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA501283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578795803Medicaid
CA5635656OtherNCPDP