MEDICARE: LISA BARON QUINONEZ RPH

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	PS33364	FL

General Provider Information

NPI Number	:	1548859853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BARON QUINONEZ RPH

Provider Business Mailing Address
First Line	:	1523 E COMMERCIAL BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33334-5717
Country	:	US
Telephone Number	:	754-200-5913
Fax Number	:	754-223-3424

Provider Business Practice Location Address
First Line	:	1523 E COMMERCIAL BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33334-5717
Country	:	US
Telephone Number	:	754-200-5913
Fax Number	:	754-223-3424

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

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	01/12/2021

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