Provider Demographics
NPI:1790330322
Name:QUIJANO, PAOLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:
Last Name:QUIJANO
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 1:705 E LAMB
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76530-5414
Mailing Address - Country:US
Mailing Address - Phone:817-823-4342
Mailing Address - Fax:
Practice Address - Street 1:700 S OCHOA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-2936
Practice Address - Country:US
Practice Address - Phone:915-545-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist