Provider Demographics
NPI:1972682649
Name:QUALITY DRUG LONG TERM CARE
Entity Type:Organization
Organization Name:QUALITY DRUG LONG TERM CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PHRM
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOIXVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:949-673-1996
Mailing Address - Street 1:3471 VIA LIDO
Mailing Address - Street 2:STE 211
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3471 VIA LIDO
Practice Address - Street 2:STE 211
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3912
Practice Address - Country:US
Practice Address - Phone:949-673-1996
Practice Address - Fax:949-673-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY471003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5615565OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5615565OtherOTHER ID NUMBER