=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972642775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICK QUINN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 01/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 ALCORN DR
-----------------------------------------------------
City | CORINTH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38834-9359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-286-6991
-----------------------------------------------------
Fax | 662-287-6280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 ALCORN DR
-----------------------------------------------------
City | CORINTH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38834-9359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-286-6991
-----------------------------------------------------
Fax | 662-287-6280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST OWNER
-----------------------------------------------------
Name | MR. RICK W QUINN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 662-286-6991
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0135101.1
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------