MEDICARE: MARK QUINONES

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	PS27743	FL

General Provider Information

NPI Number	:	1891064697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK QUINONES

Provider Business Mailing Address
First Line	:	15792 FISHHAWK FALLS DR
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-3818
Country	:	US
Telephone Number	:	813-385-2090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1802 JIM REDMAN PKWY
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-6914
Country	:	US
Telephone Number	:	813-752-6192
Fax Number	:

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

Provider Enumeration Date	:	12/22/2011
Last Update Date	:	12/22/2011

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Directions to “ MARK QUINONES ” Practice Location

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