Provider Demographics
NPI:1467971820
Name:DALL, QUINTON EDWARD (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:QUINTON
Middle Name:EDWARD
Last Name:DALL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49281 GRAPEFRUIT BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1486
Mailing Address - Country:US
Mailing Address - Phone:760-296-3468
Mailing Address - Fax:760-296-3438
Practice Address - Street 1:49281 GRAPEFRUIT BLVD
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1487
Practice Address - Country:US
Practice Address - Phone:760-296-3468
Practice Address - Fax:760-296-3438
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56835OtherPHARMACY BOARD