Provider Demographics
NPI:1629672035
Name:QUENIN, PATTERSON FESTUS (RPH)
Entity Type:Individual
Prefix:MR
First Name:PATTERSON
Middle Name:FESTUS
Last Name:QUENIN
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 1:8139 TARA BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3142
Mailing Address - Country:US
Mailing Address - Phone:404-518-5288
Mailing Address - Fax:
Practice Address - Street 1:8139 TARA BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3142
Practice Address - Country:US
Practice Address - Phone:404-518-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0248543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy