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General NPI Number Information
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NPI Number | 1295818342
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Entity Type | Organization
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Legal Business Name | QUALI-CARE HEALTH CORPORATION
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 11/04/2010
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Provider Practice Location Address
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Address Line | 3737 MARTIN LUTHER KING JR BLVD SUITE 101
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City | LYNWOOD
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State | CA
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Zip | 90262-3513
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Country | US
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Telephone | 310-537-1440
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 368
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City | MONTROSE
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State | CA
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Zip | 91021-0368
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KHANH HORNE
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Credential |
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Telephone | 310-537-1440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY49113
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License Number State | CA
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