Provider Demographics
NPI:1609302397
Name:LUXOR PHARMACY CORP
Entity Type:Organization
Organization Name:LUXOR PHARMACY CORP
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:BESKHAYROUN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:951-406-1521
Mailing Address - Street 1:10465 ARLINGTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1103
Mailing Address - Country:US
Mailing Address - Phone:951-406-1521
Mailing Address - Fax:951-406-1520
Practice Address - Street 1:10465 ARLINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1103
Practice Address - Country:US
Practice Address - Phone:951-406-1521
Practice Address - Fax:951-406-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
CAPHY561653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169208OtherPK