Provider Demographics
NPI:1083740104
Name:QUILLEN, AMY E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:QUILLEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:941-979-9085
Mailing Address - Fax:941-979-8146
Practice Address - Street 1:3370 TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-979-9085
Practice Address - Fax:941-979-8146
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist