Healthcare Provider Details

I. General information

NPI: 1487920542
Provider Name (Legal Business Name): CAREQUEST PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 CANBY AVE STE 108
RESEDA CA
91335-4391
US

IV. Provider business mailing address

6901 CANBY AVE STE 108
RESEDA CA
91335-4391
US

V. Phone/Fax

Practice location:
  • Phone: 310-849-9535
  • Fax:
Mailing address:
  • Phone: 310-849-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY 50419
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. FARAMARZ GANJIAN
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 310-849-9535