Organization
QUALITY DRUG LONG TERM CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE KOIXVER PHRMD (VP PHRM)
(949) 673-1996
Entity
Organization
Contact information
Practice address
3471 VIA LIDO, STE 211, NEWPORT BEACH, CA 92663-3912
(949) 673-1996
(949) 673-1937
Mailing address
3471 VIA LIDO, STE 211, NEWPORT BEACH, CA 92663-3912
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PHY47100
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5615565
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/03/2006
Last updated
08/30/2007
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