Healthcare Provider Details

I. General information

NPI: 1801468541
Provider Name (Legal Business Name): QRCPC PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 CHERRY ST STE A
PANAMA CITY FL
32404-6734
US

IV. Provider business mailing address

5620 CHERRY ST STE A
PANAMA CITY FL
32404-6734
US

V. Phone/Fax

Practice location:
  • Phone: 850-388-4333
  • Fax: 850-388-4338
Mailing address:
  • Phone: 850-388-4333
  • Fax: 850-388-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. TIM R. MIXON
Title or Position: PRESIDENT
Credential:
Phone: 850-388-4333