MEDICARE: MABEL QUINTERO R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS39904	FL

General Provider Information

NPI Number	:	1548304512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MABEL QUINTERO R.PH.

Provider Business Mailing Address
First Line	:	3322 HOUSATONIC DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5029
Country	:	US
Telephone Number	:	561-967-8758
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5808
Country	:	US
Telephone Number	:	561-967-3528
Fax Number	:	561-967-4032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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