1669649786 NPI number — Q PHARMACY INC

Table of content: MS. BROOKE H KROTO LISW (NPI 1922174390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669649786 NPI number — Q PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Q PHARMACY INC
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:
Provider Other Organization Name Type Code:
6
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:
1669649786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
512 VICTORIA LN
Provider Second Line Business Mailing Address:
UNIT 7
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78550-3226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-489-4931
Provider Business Mailing Address Fax Number:
210-579-6871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
512 VICTORIA LN
Provider Second Line Business Practice Location Address:
UNIT 7
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-3226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-489-4931
Provider Business Practice Location Address Fax Number:
210-579-6871
Provider Enumeration Date:
05/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TAMI
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-489-4931

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  26019 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 26019 . This is a "TEXAS STATE BOARD OF PHARMACY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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