NPIMap

Organization Active NPI

Pharmedquest Pharmacy Services

Doing business as Avita Pharmacy 1072

  • Community/Retail Pharmacy
  • Mission Viejo, CA
National Provider Identifier
1447904982
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 1072
Practice address
26800 Crown Valley Pkwy Ste 185
Mission Viejo, CA 92691-7304
Phone
(949) 364-9009
Fax
(949) 364-9002
NPI assigned
Feb 3, 2022
Organization subpart
Yes
Parent organization
PHARMEDQUEST PHARMACY SERVICESAs reported in NPPES

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 1

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

Addresses

Primary practice location

26800 Crown Valley Pkwy Ste 185
Mission Viejo, CA 92691-7304

Mailing address

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

Other names 1

  • Avita Pharmacy 1072 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
Part of
Pharmedquest Pharmacy

Other organizations with this tax ID 13

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

View all 13

Locations

330 E Lambert Rd
Ste 100
Brea, CA 92821
Phone (714) 457-0272

26800 Crown Valley Pkwy
Ste 185
Mission Viejo, CA 92691
Phone (949) 364-9009

NPI Registry JSON

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

{
    "created_epoch": "1643846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1447904982",
    "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": "26800 CROWN VALLEY PKWY STE 185",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926917304",
            "telephone_number": "949-364-9009",
            "fax_number": "949-364-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMEDQUEST PHARMACY SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHARMEDQUEST PHARMACY SERVICES",
        "enumeration_date": "2022-02-03",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita Pharmacy 1072",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avita Pharmacy 1072",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mission Viejo, 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.