Healthcare Provider Details

I. General information

NPI: 1639289846
Provider Name (Legal Business Name): QUIN C. HOSTETLER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 8TH ST STE 1A106
SPRINGFIELD IL
62701-1041
US

IV. Provider business mailing address

35 WOODLAND TRL
ROCHESTER IL
62563-9553
US

V. Phone/Fax

Practice location:
  • Phone: 217-789-4355
  • Fax:
Mailing address:
  • Phone: 217-498-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: