Provider Demographics
NPI:1144297342
Name:HEALTH QUEST COMPOUNDING PHARMACY INC
Entity type:Organization
Organization Name:HEALTH QUEST COMPOUNDING PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WITLICKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:440-632-0111
Mailing Address - Street 1:14895 N STATE AVE
Mailing Address - Street 2:UNIT D PO BOX 336
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062
Mailing Address - Country:US
Mailing Address - Phone:440-632-0111
Mailing Address - Fax:440-632-0133
Practice Address - Street 1:14895 N STATE AVE
Practice Address - Street 2:UNIT D PO
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062
Practice Address - Country:US
Practice Address - Phone:440-632-0111
Practice Address - Fax:440-632-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2365113Medicaid
3671078OtherNABP
=========Medicare UPIN