Provider Demographics
NPI:1679183743
Name:QUINN, SHANNON MAI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MAI
Last Name:QUINN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 26TH ST W APT 804
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-3769
Mailing Address - Country:US
Mailing Address - Phone:941-920-1103
Mailing Address - Fax:
Practice Address - Street 1:2901 26TH ST W APT 804
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-3769
Practice Address - Country:US
Practice Address - Phone:941-920-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist