NPIMap

Organization Active NPI

Pharmedquest Pharmacy Services

Doing business as Avita Pharmacy 1014

  • Community/Retail Pharmacy
  • Lancaster, CA
National Provider Identifier
1154961837
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PHARMEDQUEST PHARMACY SERVICES
Doing business as
Avita Pharmacy 1014
Practice address
45104 10TH St W Ste a
Lancaster, CA 93534-2310
Phone
(661) 485-7528
NPI assigned
Jan 10, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carl Cody Colquitt
Title
Cfo
Phone
(469) 592-2011

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

45104 10TH St W Ste a
Lancaster, CA 93534-2310

Mailing address

10604 Coursey Blvd
Baton Rouge, LA 70816-4015
Phone (714) 599-8181

Other identifiers 1

IdentifierTypeStateIssuer
1154961837MedicaidCA

Other names 1

  • Avita Pharmacy 1014 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100928001413 CA Part B Supplier - Pharmacy 1850421470 12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pomona, CA; North Hollywood, CA; Mission Viejo, CA; Lynwood, CA; Los Angeles, CA; Lancaster, CA; Covina, CA; Brea, CA

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Pharmedquest Pharmacy14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

45104 10th St W
Ste A
Lancaster, CA 93534
Phone (661) 485-7528

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1154961837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10604 COURSEY BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708164015",
            "telephone_number": "714-599-8181",
            "fax_number": "714-599-8242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45104 10TH ST W STE A",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935342310",
            "telephone_number": "661-485-7528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMEDQUEST PHARMACY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-10",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "COLQUITT",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "CODY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "469-592-2011"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154961837",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita Pharmacy 1014",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lancaster, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.