Healthcare Provider Details

I. General information

NPI: 1891107066
Provider Name (Legal Business Name): PHARMEDQUEST PHARMACY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 S SAN PEDRO ST
LOS ANGELES CA
90013-2102
US

IV. Provider business mailing address

10604 COURSEY BLVD
BATON ROUGE LA
70816-4015
US

V. Phone/Fax

Practice location:
  • Phone: 213-443-8627
  • Fax: 213-627-4011
Mailing address:
  • Phone: 657-286-7957
  • Fax: 714-599-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number51788
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. DALILA IBARRA
Title or Position: LICENSING & CREDENTIALING COORDINAT
Credential:
Phone: 657-286-7957