Healthcare Provider Details

I. General information

NPI: 1902572613
Provider Name (Legal Business Name): STEVEN WYATT O'QUINN PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2021
Last Update Date: 08/22/2021
Certification Date: 08/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 N MAYO TRL
PIKEVILLE KY
41501-3210
US

IV. Provider business mailing address

4209 N MAYO TRL
PIKEVILLE KY
41501-3210
US

V. Phone/Fax

Practice location:
  • Phone: 606-432-0331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022319
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: