Healthcare Provider Details

I. General information

NPI: 1750149506
Provider Name (Legal Business Name): LIFE QUEST PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 JUPITER LAKES BLVD STE B
JUPITER FL
33458-7196
US

IV. Provider business mailing address

140 JUPITER LAKES BLVD STE B
JUPITER FL
33458-7196
US

V. Phone/Fax

Practice location:
  • Phone: 561-668-2213
  • Fax: 561-401-9300
Mailing address:
  • Phone: 954-914-3652
  • Fax:

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 Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID PANTLEY
Title or Position: OWNER
Credential:
Phone: 561-262-3588