Provider Demographics
NPI:1861484214
Name:QC PHARMACY CORP
Entity Type:Organization
Organization Name:QC PHARMACY CORP
Other - Org Name:QUALITY CARE PHARMACYT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEEJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:617-640-4576
Mailing Address - Street 1:727 W SAN MARCOS BLVD
Mailing Address - Street 2:STE 113
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1244
Mailing Address - Country:US
Mailing Address - Phone:760-744-5959
Mailing Address - Fax:760-744-5960
Practice Address - Street 1:727 W SAN MARCOS BLVD
Practice Address - Street 2:STE 113
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1244
Practice Address - Country:US
Practice Address - Phone:760-744-5959
Practice Address - Fax:760-744-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY39483333600000X
CA394833336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA394830Medicaid
CA0542870OtherNABP NUMBER
BQ3768491OtherDEA NUMBER
CAPHA394830Medicaid