Healthcare Provider Details

I. General information

NPI: 1760508303
Provider Name (Legal Business Name): JOSEPH CRUZ QUINATA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTH ROUTE 2 SUITE A106
AGAT GU
96928
US

IV. Provider business mailing address

167 TALISAY DR
SANTA RITA GU
96915
US

V. Phone/Fax

Practice location:
  • Phone: 671-565-3043
  • Fax: 671-565-3048
Mailing address:
  • Phone: 671-565-2540
  • Fax: 671-565-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH024
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: