Healthcare Provider Details

I. General information

NPI: 1770160632
Provider Name (Legal Business Name): QUANTUMHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 E ALLUVIAL AVE STE 116
FRESNO CA
93720-2688
US

IV. Provider business mailing address

1281 E ALLUVIAL AVE STE 116
FRESNO CA
93720-2688
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-1190
  • Fax: 559-439-1655
Mailing address:
  • Phone: 559-439-1190
  • Fax: 559-439-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DIANA LYNN SMITH LAURENT
Title or Position: OWNER/PIC
Credential: PHARMD
Phone: 559-439-1190