Provider Demographics
NPI:1376836239
Name:QUICK, JOHN DOWARD III
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DOWARD
Last Name:QUICK
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 HORTON RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2005
Mailing Address - Country:US
Mailing Address - Phone:919-471-3580
Mailing Address - Fax:919-471-3643
Practice Address - Street 1:1501 HORTON RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2005
Practice Address - Country:US
Practice Address - Phone:919-471-3580
Practice Address - Fax:919-471-3643
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34611790781QMedicaid