Provider Demographics
NPI:1104436542
Name:GUADALUPE PHARMACY INC
Entity type:Organization
Organization Name:GUADALUPE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:562-630-1620
Mailing Address - Street 1:16444 PARAMOUNT BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5453
Mailing Address - Country:US
Mailing Address - Phone:562-232-3732
Mailing Address - Fax:562-232-3651
Practice Address - Street 1:16444 PARAMOUNT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5453
Practice Address - Country:US
Practice Address - Phone:562-232-3732
Practice Address - Fax:562-232-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57781OtherBOARD OF PHARMACY PERMIT