Provider Demographics
NPI:1326035528
Name:QUINN, RICK W (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:W
Last Name:QUINN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ALCORN DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9359
Mailing Address - Country:US
Mailing Address - Phone:662-286-6991
Mailing Address - Fax:662-287-8087
Practice Address - Street 1:111 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9359
Practice Address - Country:US
Practice Address - Phone:662-286-6991
Practice Address - Fax:662-287-8087
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440678Medicaid
MS0327840001Medicare NSC