Provider Demographics
NPI:1477192110
Name:QUEN, CARMEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:QUEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S ELM ST APT 14A
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3736
Mailing Address - Country:US
Mailing Address - Phone:213-220-0130
Mailing Address - Fax:
Practice Address - Street 1:3960 BROAD ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7018
Practice Address - Country:US
Practice Address - Phone:213-220-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist