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General NPI Number Information
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NPI Number | 1689110819
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Entity Type | Organization
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Legal Business Name | QUOGEN LLC
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Dates
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Enumeration Date | 01/11/2017
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Last Update Date | 01/11/2017
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Provider Practice Location Address
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Address Line | 535 E MCKELLIPS RD SUITE 121
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City | MESA
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State | AZ
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Zip | 85203-2522
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Country | US
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Telephone | 480-685-1027
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Fax |
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Provider Business Mailing Address
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Address Line | 535 E MCKELLIPS RD SUITE 121
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City | MESA
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State | AZ
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Zip | 85203-2522
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Country | US
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Telephone | 480-685-1027
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Fax |
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Authorized Official
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Title or Position | RESIDENT GENIUS
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Name | MR. NELSON P SPARKS II
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Credential |
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Telephone | 480-685-1027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State | AZ
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