Provider Demographics
NPI:1396888327
Name:PACIFIC HEALTHCARE PHARMACY LLC
Entity type:Organization
Organization Name:PACIFIC HEALTHCARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:MARQUEZ
Authorized Official - Last Name:QUERIMIT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:671-649-6831
Mailing Address - Street 1:1757 GUAM BUSINESS CENTER BUILDING, ROUTE 16
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HARMON
Mailing Address - State:GU
Mailing Address - Zip Code:96929
Mailing Address - Country:US
Mailing Address - Phone:671-649-6831
Mailing Address - Fax:671-649-6832
Practice Address - Street 1:1757 GUAM BUSINESS CENTER BUILDING, ROUTE 16
Practice Address - Street 2:SUITE 108
Practice Address - City:HARMON
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-649-6831
Practice Address - Fax:671-649-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPCY0253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU5410826OtherNCPDP NUMBER