Healthcare Provider Details

I. General information

NPI: 1467418715
Provider Name (Legal Business Name): GORDON QUINN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 JACK SPRINGS RD
ATMORE AL
36502-5025
US

IV. Provider business mailing address

1732 OLD BRATT RD
ATMORE AL
36502-7646
US

V. Phone/Fax

Practice location:
  • Phone: 251-368-8630
  • Fax:
Mailing address:
  • Phone: 251-368-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8086
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: