Provider Demographics
NPI:1912533159
Name:LA BARAKA 1188, INC
Entity Type:Organization
Organization Name:LA BARAKA 1188, INC
Other - Org Name:SIX 55 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABERGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-993-8726
Mailing Address - Street 1:655 W AVENUE Q STE E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3894
Mailing Address - Country:US
Mailing Address - Phone:661-526-7655
Mailing Address - Fax:661-526-7657
Practice Address - Street 1:655 W AVENUE Q STE E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3894
Practice Address - Country:US
Practice Address - Phone:661-526-7655
Practice Address - Fax:661-526-7657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy