=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184505547
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN QAQUNDAH PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2025
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 INDUSTRIAL RD
-----------------------------------------------------
City | SAN CARLOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94070-2603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-713-9297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 370521
-----------------------------------------------------
City | MONTARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94037-0521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-713-9297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Pharmacist
-----------------------------------------------------
License Number | RPH43869
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------