Provider Demographics
NPI:1598816589
Name:QUEST PHARMACY INC
Entity Type:Organization
Organization Name:QUEST PHARMACY INC
Other - Org Name:QUEST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-544-1489
Mailing Address - Street 1:602 ADELINE ST
Mailing Address - Street 2:STE E
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3802
Mailing Address - Country:US
Mailing Address - Phone:601-544-1489
Mailing Address - Fax:601-544-1491
Practice Address - Street 1:602 ADELINE ST STE E
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3802
Practice Address - Country:US
Practice Address - Phone:601-544-1489
Practice Address - Fax:601-544-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS061740233336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06281706Medicaid
2047093OtherPK
5366210001Medicare NSC