Provider Demographics
NPI:1386205524
Name:QUINATE PHARMACY LLC
Entity Type:Organization
Organization Name:QUINATE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-988-1780
Mailing Address - Street 1:1569 GA HIGHWAY 21 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-5214
Mailing Address - Country:US
Mailing Address - Phone:912-754-2200
Mailing Address - Fax:
Practice Address - Street 1:1569 GA HIGHWAY 21 S
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-5214
Practice Address - Country:US
Practice Address - Phone:912-754-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE010724OtherSTATE BOARD OF PHARMACY