Healthcare Provider Details

I. General information

NPI: 1043320369
Provider Name (Legal Business Name): JOE R QUINTANA 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

5001 N PIEDRAS ST
EL PASO TX
79930-4210
US

IV. Provider business mailing address

6104 NAVAJO AVE
EL PASO TX
79925-3404
US

V. Phone/Fax

Practice location:
  • Phone: 915-564-7943
  • Fax: 915-564-7801
Mailing address:
  • Phone: 915-564-7943
  • Fax: 915-564-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25352
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: