NPIMap

Organization Active NPI

Pharmedquest Pharmacy Services

Doing business as Avita Pharmacy 1001

  • Pharmacy
  • Los Angeles, CA
National Provider Identifier
1891107066
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
51788 Issued in CA
Legal business name
PHARMEDQUEST PHARMACY SERVICES
Doing business as
Avita Pharmacy 1001
Practice address
522 S San Pedro St
Los Angeles, CA 90013-2102
Phone
(213) 443-8627
Fax
(213) 627-4011
NPI assigned
May 22, 2014
Last updated
Sep 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Authorized official

Name
Ms. Dalila Ibarra
Title
Licensing & Credentialing Coordinat
Phone
(657) 286-7957

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 51788 CA Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

522 S San Pedro St
Los Angeles, CA 90013-2102

Mailing address

10604 Coursey Blvd
Baton Rouge, LA 70816-4015
Phone (657) 286-7957

Other identifiers 1

IdentifierTypeStateIssuer
1891107066MedicaidCA

Other names 1

  • Avita Pharmacy 1001 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 Pharmacy Services14 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

NPI Registry JSON

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694476800000",
    "number": "1891107066",
    "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": "657-286-7957",
            "fax_number": "714-599-8242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900132102",
            "telephone_number": "213-443-8627",
            "fax_number": "213-627-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMEDQUEST PHARMACY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-22",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A",
        "authorized_official_last_name": "IBARRA",
        "authorized_official_first_name": "DALILA",
        "authorized_official_title_or_position": "LICENSING & CREDENTIALING COORDINAT",
        "authorized_official_telephone_number": "657-286-7957",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "51788",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891107066",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita Pharmacy 1001",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; 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.