Healthcare Provider Details

I. General information

NPI: 1184055584
Provider Name (Legal Business Name): FUSION QUEST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 PACIFIC AVE UNIT 100
LONG BEACH CA
90806-2657
US

IV. Provider business mailing address

2690 PACIFIC AVE UNIT 100
LONG BEACH CA
90806-2657
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-3777
  • Fax: 562-424-3775
Mailing address:
  • Phone: 562-424-3777
  • Fax: 562-424-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. NOUSHIN A LAALY
Title or Position: SECRETARY/ RPH
Credential: PHARM D
Phone: 562-424-3777