Provider Demographics
NPI:1235282203
Name:MED QUICK PRESCRIPTION SHOPPE
Entity Type:Organization
Organization Name:MED QUICK PRESCRIPTION SHOPPE
Other - Org Name:MED QUICK PRESCRIPTION SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:626-281-2015
Mailing Address - Street 1:546 W LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1111
Mailing Address - Country:US
Mailing Address - Phone:626-281-2015
Mailing Address - Fax:626-281-2055
Practice Address - Street 1:546 W LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1111
Practice Address - Country:US
Practice Address - Phone:626-281-2015
Practice Address - Fax:626-281-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336H0001X, 3336L0003X
CAPHY499773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121586OtherPK