Organization
PHARMEDQUEST PHARMACY SERVICES
Active
Other names
Avita Pharmacy 1012
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DALILA IBARRA (LICENSING & CREDENTIALING COORDINAT)
(657) 286-7957
Entity
Organization
Contact information
Practice address
420 S GLENDORA AVE, WEST COVINA, CA 91790-3001
(626) 869-2470
(626) 919-1295
Mailing address
10604 COURSEY BLVD, BATON ROUGE, LA 70816-4015
(714) 599-8181
(714) 599-8242
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
53301
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497142251
—
CA
Enumeration date
04/20/2015
Last updated
03/14/2024
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