Healthcare Provider Details

I. General information

NPI: 1689399255
Provider Name (Legal Business Name): KENNETH RAYMOND QUAN PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 EL CAMINO REAL
CARLSBAD CA
92008-1273
US

IV. Provider business mailing address

14781 POMERADO RD # 122
POWAY CA
92064-2802
US

V. Phone/Fax

Practice location:
  • Phone: 760-729-8941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: