Provider Demographics
NPI:1831110881
Name:FSQ PHARMACY HOLDINGS LLC
Entity Type:Organization
Organization Name:FSQ PHARMACY HOLDINGS LLC
Other - Org Name:ROYAL HILLS RETAIL PHCY SVCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHCY OPS
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8288
Mailing Address - Street 1:7301 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1904
Mailing Address - Country:US
Mailing Address - Phone:818-887-4670
Mailing Address - Fax:818-887-0473
Practice Address - Street 1:7301 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1904
Practice Address - Country:US
Practice Address - Phone:818-887-4670
Practice Address - Fax:818-887-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X, 3336L0003X
CAPHY474163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0551653OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA474160Medicaid
CA5596050001Medicare NSC