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General NPI Number Information
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NPI Number | 1891064697
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Entity Type | Individual
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Provider Name | MARK QUINONES
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Gender | Male
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 1802 JIM REDMAN PKWY
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City | PLANT CITY
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State | FL
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Zip | 33563-6914
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Country | US
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Telephone | 813-752-6192
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Fax |
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Provider Business Mailing Address
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Address Line | 15792 FISHHAWK FALLS DR
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City | LITHIA
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State | FL
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Zip | 33547-3818
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Country | US
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Telephone | 813-385-2090
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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 | PS27743
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License Number State | FL
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