Provider Demographics
NPI:1316551674
Name:QUAKA, PAULA JANE
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JANE
Last Name:QUAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 W WAR MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5552
Mailing Address - Country:US
Mailing Address - Phone:309-688-5209
Mailing Address - Fax:309-688-5099
Practice Address - Street 1:2324 W WAR MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5552
Practice Address - Country:US
Practice Address - Phone:309-685-5209
Practice Address - Fax:309-688-5099
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist