Provider Demographics
NPI:1942282884
Name:SUPER CARE DRUGS INC
Entity Type:Organization
Organization Name:SUPER CARE DRUGS INC
Other - Org Name:SUPER CARE DRUGS-MALIBU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:310-456-1177
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 1:23357 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4957
Practice Address - Country:US
Practice Address - Phone:310-456-9059
Practice Address - Fax:310-456-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY46214333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy