Provider Demographics
NPI:1629010400
Name:QUINLANS PHARMACY INC
Entity Type:Organization
Organization Name:QUINLANS PHARMACY INC
Other - Org Name:QUINLAN'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-728-9120
Mailing Address - Street 1:107 N MAIN ST
Mailing Address - Street 2:STE B
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-1033
Mailing Address - Country:US
Mailing Address - Phone:585-728-2080
Mailing Address - Fax:585-728-2198
Practice Address - Street 1:107 N MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-1033
Practice Address - Country:US
Practice Address - Phone:585-728-2080
Practice Address - Fax:585-728-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X
NY0232413336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01762752Medicaid
2064291OtherPK
2064291OtherPK
NY01762752Medicaid