Provider Demographics
NPI:1487920542
Name:CAREQUEST PHARMACY
Entity type:Organization
Organization Name:CAREQUEST PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FARAMARZ
Authorized Official - Middle Name:
Authorized Official - Last Name:GANJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:310-849-9535
Mailing Address - Street 1:6901 CANBY AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4391
Mailing Address - Country:US
Mailing Address - Phone:310-849-9535
Mailing Address - Fax:
Practice Address - Street 1:6901 CANBY AVE STE 108
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4391
Practice Address - Country:US
Practice Address - Phone:310-849-9535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 504193336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy