Provider Demographics
NPI:1710697685
Name:O'QUINN, DAVID WAYNE
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:O'QUINN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 UPPER LONG BR
Mailing Address - Street 2:
Mailing Address - City:EZEL
Mailing Address - State:KY
Mailing Address - Zip Code:41425-8654
Mailing Address - Country:US
Mailing Address - Phone:606-356-7605
Mailing Address - Fax:606-743-2187
Practice Address - Street 1:412 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-2049
Practice Address - Country:US
Practice Address - Phone:606-356-7605
Practice Address - Fax:606-743-2187
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist