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General NPI Number Information
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NPI Number | 1518434638
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Entity Type | Individual
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Provider Name | ELLESSE NICOLE QUIJANO PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/26/2018
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 8315 MAGNOLIA ESTATES DR
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City | CORNELIUS
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State | NC
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Zip | 28031-7837
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Country | US
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Telephone | 704-895-7062
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Fax |
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Provider Business Mailing Address
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Address Line | 2324 MCCLINTOCK RD UNIT A208
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City | CHARLOTTE
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State | NC
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Zip | 28205-5229
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Country | US
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Telephone | 732-606-7176
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 38032
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28398
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License Number State | NC
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