Healthcare Provider Details

I. General information

NPI: 1053182709
Provider Name (Legal Business Name): THE QUEEN RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N TUSTIN ST
ORANGE CA
92867-5147
US

IV. Provider business mailing address

1233 N TUSTIN ST
ORANGE CA
92867-5147
US

V. Phone/Fax

Practice location:
  • Phone: 714-288-1720
  • Fax: 714-288-1722
Mailing address:
  • Phone: 714-288-1720
  • Fax: 714-288-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MANAL MIKHAIL
Title or Position: OWNER
Credential: RPH
Phone: 714-288-1720