Provider Demographics
NPI:1568170439
Name:QUINLAN PHARMACY L P
Entity Type:Organization
Organization Name:QUINLAN PHARMACY L P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-356-2449
Mailing Address - Street 1:733 E QUINLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:QUINLAN
Mailing Address - State:TX
Mailing Address - Zip Code:75474-8641
Mailing Address - Country:US
Mailing Address - Phone:903-356-2449
Mailing Address - Fax:903-356-4797
Practice Address - Street 1:733 E QUINLAN PKWY
Practice Address - Street 2:
Practice Address - City:QUINLAN
Practice Address - State:TX
Practice Address - Zip Code:75474-8641
Practice Address - Country:US
Practice Address - Phone:903-356-2449
Practice Address - Fax:903-356-4797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1003911876Medicaid
TX148313Medicaid
TX06727901Medicaid
TX0960560001Medicaid