Provider Demographics
NPI:1093880908
Name:QUICKRX LLC
Entity Type:Organization
Organization Name:QUICKRX LLC
Other - Org Name:BREWSTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJJALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-986-5593
Mailing Address - Street 1:PO BOX 2130
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812
Mailing Address - Country:US
Mailing Address - Phone:509-689-2421
Mailing Address - Fax:509-689-2068
Practice Address - Street 1:811 US HWY 97
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812
Practice Address - Country:US
Practice Address - Phone:509-689-2421
Practice Address - Fax:509-689-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X, 1835P0018X, 333600000X
WAPHAR.CF.608108823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2167145Medicaid
2175343OtherPK
WA4902626OtherNABP