Provider Demographics
NPI:1598897068
Name:PACE, TED QUINTON JR (PHARMD, MT(ASCP))
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:QUINTON
Last Name:PACE
Suffix:JR
Gender:M
Credentials:PHARMD, MT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 W HIGHWAY 72
Mailing Address - Street 2:APT. 1
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-7133
Mailing Address - Country:US
Mailing Address - Phone:606-574-8817
Mailing Address - Fax:
Practice Address - Street 1:2478 S US HIGHWAY 421
Practice Address - Street 2:WOODLAND PLAZA
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-1727
Practice Address - Country:US
Practice Address - Phone:606-573-7200
Practice Address - Fax:606-574-0406
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist