MEDICARE: QUIQ INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3995935	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1407142334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUIQ INC

Provider Business Mailing Address
First Line	:	40 GENERAL WARREN BLVD
Second Line	:	SUITE 160
City	:	MALVERN
State	:	PA
Zip	:	19355-1251
Country	:	US
Telephone Number	:	484-328-3048
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 NORRISTOWN RD STE 202
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-2323
Country	:	US
Telephone Number	:	610-828-7221
Fax Number	:	484-328-3041

Authorized Official
Title or Position	:	CIO
Name	:	DAN BLACK
Credential	:
Telephone Number	:	484-645-3141

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	02/14/2013

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Directions to “QUIQ INC ” Practice Location

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