Provider Demographics
NPI:1902392376
Name:QUINTANA, LAURENE ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURENE
Middle Name:ANNE
Last Name:QUINTANA
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 1:6050 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5042
Mailing Address - Country:US
Mailing Address - Phone:305-740-9696
Mailing Address - Fax:305-740-9778
Practice Address - Street 1:6050 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5042
Practice Address - Country:US
Practice Address - Phone:305-740-9696
Practice Address - Fax:305-740-9778
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS50496OtherLICENSE