Organization
PHARMEDQUEST PHARMACY SERVICES
Active
Other names
Avita Pharmacy 1001
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DALILA IBARRA (LICENSING & CREDENTIALING COORDINAT)
(657) 286-7957
Entity
Organization
Contact information
Practice address
522 S SAN PEDRO ST, LOS ANGELES, CA 90013-2102
(213) 443-8627
(213) 627-4011
Mailing address
10604 COURSEY BLVD, BATON ROUGE, LA 70816-4015
(657) 286-7957
(714) 599-8242
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
51788
CA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891107066
—
CA
Enumeration date
05/22/2014
Last updated
09/12/2023
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