Healthcare Provider Details

I. General information

NPI: 1144297342
Provider Name (Legal Business Name): HEALTH QUEST COMPOUNDING PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14895 N STATE AVE UNIT D PO
MIDDLEFIELD OH
44062
US

IV. Provider business mailing address

14895 N STATE AVE UNIT D PO BOX 336
MIDDLEFIELD OH
44062
US

V. Phone/Fax

Practice location:
  • Phone: 440-632-0111
  • Fax: 440-632-0133
Mailing address:
  • Phone: 440-632-0111
  • Fax: 440-632-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. RONALD JAMES WITLICKI
Title or Position: PRESIDENT
Credential: RPH
Phone: 440-632-0111