Provider Demographics
NPI:1851692347
Name:SUPER CARE DRUGS - BEVERLY HILLS LLC
Entity Type:Organization
Organization Name:SUPER CARE DRUGS - BEVERLY HILLS LLC
Other - Org Name:SUPER CARE DRUGS - BEVERLY HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-271-2111
Mailing Address - Street 1:23661 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4825
Mailing Address - Country:US
Mailing Address - Phone:310-456-1177
Mailing Address - Fax:310-456-6529
Practice Address - Street 1:220 N CANON DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5302
Practice Address - Country:US
Practice Address - Phone:310-271-2111
Practice Address - Fax:310-271-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA504003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127500OtherPK