MEDICARE: MICHELLE JUNE QUINTANILLA PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	40794	TX

General Provider Information

NPI Number	:	1376871384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE JUNE QUINTANILLA PHARM.D.

Provider Business Mailing Address
First Line	:	7423 BROADWAY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3221
Country	:	US
Telephone Number	:	210-821-6992
Fax Number	:	210-821-6632

Provider Business Practice Location Address
First Line	:	7423 BROADWAY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3221
Country	:	US
Telephone Number	:	210-821-6992
Fax Number	:	210-821-6632

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2009
Last Update Date	:	12/02/2009

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