Healthcare Provider Details

I. General information

NPI: 1831110881
Provider Name (Legal Business Name): FSQ PHARMACY HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 MEDICAL CENTER DR
WEST HILLS CA
91307-1904
US

IV. Provider business mailing address

7301 MEDICAL CENTER DR
WEST HILLS CA
91307-1904
US

V. Phone/Fax

Practice location:
  • Phone: 818-887-4670
  • Fax: 818-887-0473
Mailing address:
  • Phone: 818-887-4670
  • Fax: 818-887-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY47416
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVEN BERRY
Title or Position: VP PHCY OPS
Credential:
Phone: 617-796-8288