Healthcare Provider Details

I. General information

NPI: 1083617740
Provider Name (Legal Business Name): LA QUINTA PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78150 CALLE TAMPICO STE 103
LA QUINTA CA
92253-2907
US

IV. Provider business mailing address

78150 CALLE TAMPICO STE 103
LA QUINTA CA
92253-2907
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-9902
  • Fax: 760-777-9820
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number46507
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARSHALL HANKIN
Title or Position: OWNER AND PHARMACIST
Credential: RPH
Phone: 760-777-9902