Provider Demographics
NPI:1578565248
Name:QUINONES, ERICK J (RPH)
Entity Type:Individual
Prefix:MR
First Name:ERICK
Middle Name:J
Last Name:QUINONES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19723
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1723
Mailing Address - Country:US
Mailing Address - Phone:787-726-0295
Mailing Address - Fax:787-726-8768
Practice Address - Street 1:2428 CALLE LOIZA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00913-4731
Practice Address - Country:US
Practice Address - Phone:787-726-0295
Practice Address - Fax:787-726-8768
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4017302OtherNCPDP
PR112909001Medicare ID - Type Unspecified