Healthcare Provider Details

I. General information

NPI: 1861484214
Provider Name (Legal Business Name): QC PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2005
Last Update Date: 03/07/2023
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 W SAN MARCOS BLVD STE 113
SAN MARCOS CA
92078-1244
US

IV. Provider business mailing address

727 W SAN MARCOS BLVD STE 113
SAN MARCOS CA
92078-1244
US

V. Phone/Fax

Practice location:
  • Phone: 760-744-5959
  • Fax: 760-744-5960
Mailing address:
  • Phone: 760-744-5959
  • Fax: 760-744-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY39483
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number39483
License Number StateCA

VIII. Authorized Official

Name: HEEJIN KIM
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 617-640-4576