Healthcare Provider Details

I. General information

NPI: 1366436180
Provider Name (Legal Business Name): MARTHA H QUARANTILLO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 IRONWOOD LN
BERKELEY SPRINGS WV
25411-6359
US

IV. Provider business mailing address

94 IRONWOOD LN
BERKELEY SPRINGS WV
25411-6359
US

V. Phone/Fax

Practice location:
  • Phone: 304-258-4417
  • Fax:
Mailing address:
  • Phone: 304-258-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4026W
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: