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General NPI Number Information
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NPI Number | 1144297342
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Entity Type | Organization
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Legal Business Name | HEALTH QUEST COMPOUNDING PHARMACY INC
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14895 N STATE AVE UNIT D PO
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City | MIDDLEFIELD
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State | OH
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Zip | 44062
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Country | US
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Telephone | 440-632-0111
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Fax | 440-632-0133
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Provider Business Mailing Address
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Address Line | 14895 N STATE AVE UNIT D PO BOX 336
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City | MIDDLEFIELD
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State | OH
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Zip | 44062
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Country | US
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Telephone | 440-632-0111
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Fax | 440-632-0133
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONALD JAMES WITLICKI
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Credential | RPH
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Telephone | 440-632-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State | OH
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