Provider Demographics
NPI:1003241258
Name:QSREX PHARMACY PROFESSIONALS
Entity Type:Organization
Organization Name:QSREX PHARMACY PROFESSIONALS
Other - Org Name:QSREX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLINS
Authorized Official - Middle Name:O
Authorized Official - Last Name:ODUKOGBE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-467-9172
Mailing Address - Street 1:301 RICE MEADOW WAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8403
Mailing Address - Country:US
Mailing Address - Phone:803-708-1229
Mailing Address - Fax:
Practice Address - Street 1:301 RICE MEADOW WAY
Practice Address - Street 2:SUITE 5
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8403
Practice Address - Country:US
Practice Address - Phone:803-708-1229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC141383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy