Organization
PHARMEDQUEST PHARMACY SERVICES
Active
Other names
Avita Pharmacy 1014
Organization subpart
No
Provider details
NPI number
Authorized official
CARL CODY COLQUITT (CFO)
(469) 592-2011
Entity
Organization
Contact information
Practice address
45104 10TH ST W STE A, LANCASTER, CA 93534-2310
(661) 485-7528
Mailing address
10604 COURSEY BLVD, BATON ROUGE, LA 70816-4015
(714) 599-8181
(714) 599-8242
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154961837
—
CA
Enumeration date
01/10/2020
Last updated
06/27/2024
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