Organization Name: | QBAUM ENTERPRISES LLC |
NPI Number: | 1154577245 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRIAN QUATTEBAUM (OWNER) |
Mailing Address: | 1101 Ne 1st St Pryor |
State: | OK US |
Postal Code: | 743614209 |
Phone Number: | 9188241300 |
Fax Number: | 9188241316 |
NPI Enumeration Date: | 08/08/2008 |
NPI Last Update Date: | 03/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Compounding Pharmacy |
Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |