Healthcare Provider Details

I. General information

NPI: 1124313978
Provider Name (Legal Business Name): QUEST RX SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 E WT HARRIS BLVD STE E-2
CHARLOTTE NC
28215-3541
US

IV. Provider business mailing address

5820 EAST W.T. HARRIS BLVD SUITE E-2
CHARLOTTE NC
28215-0023
US

V. Phone/Fax

Practice location:
  • Phone: 704-899-5100
  • Fax: 704-899-0454
Mailing address:
  • Phone: 704-899-5100
  • Fax: 704-899-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number11075
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD BANAWAN
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 704-899-5100