Provider Demographics
NPI:1710649975
Name:MCNICHOLS, QUINN (PHARMD)
Entity Type:Individual
Prefix:
First Name:QUINN
Middle Name:
Last Name:MCNICHOLS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40920 LACROIX AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6306
Mailing Address - Country:US
Mailing Address - Phone:951-294-7595
Mailing Address - Fax:
Practice Address - Street 1:7544 GIRARD AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5101
Practice Address - Country:US
Practice Address - Phone:858-494-0932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025482183500000X
CARPH86021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist