Provider Demographics
NPI:1609825173
Name:QUINN, DEREK JAMES (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JAMES
Last Name:QUINN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8822 PORTAGE ROAD
Mailing Address - Street 2:WESTLAKE DRUG, INC.
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002
Mailing Address - Country:US
Mailing Address - Phone:269-327-3049
Mailing Address - Fax:269-327-5817
Practice Address - Street 1:8822 PORTAGE RD
Practice Address - Street 2:WESTLAKE DRUG, INC.
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-6416
Practice Address - Country:US
Practice Address - Phone:269-327-3049
Practice Address - Fax:269-327-5817
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302034568OtherSTATE PHARMACY/CONTROLLED