Healthcare Provider Details

I. General information

NPI: 1679654719
Provider Name (Legal Business Name): HEALTH QUEST PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 OAK PARK BLVD #101
PISMO BEACH CA
93449
US

IV. Provider business mailing address

911 OAK PARK BLVD #101
PISMO BEACH CA
93449
US

V. Phone/Fax

Practice location:
  • Phone: 805-489-0888
  • Fax: 805-489-0288
Mailing address:
  • Phone: 805-489-0888
  • Fax: 805-489-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY47165
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHY50613
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY47165
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY47165
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50613
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY47165
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY50613
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL STEPHEN KYLE
Title or Position: PRESIDENT
Credential:
Phone: 805-489-0888