1447904982 NPI number — PHARMEDQUEST PHARMACY SERVICES

Table of content: (NPI 1447904982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447904982 NPI number — PHARMEDQUEST PHARMACY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMEDQUEST PHARMACY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AVITA PHARMACY 1072
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447904982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10604 COURSEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-4015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-599-8181
Provider Business Mailing Address Fax Number:
714-599-8242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26800 CROWN VALLEY PKWY STE 185
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-7304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-364-9009
Provider Business Practice Location Address Fax Number:
949-364-9002
Provider Enumeration Date:
02/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
COLQUITT
Authorized Official First Name:
CARL
Authorized Official Middle Name:
CODY
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
469-592-2011

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com