Provider Demographics
NPI:1134810302
Name:MCQUEEN, GINNY FOSTER
Entity type:Individual
Prefix:
First Name:GINNY
Middle Name:FOSTER
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 PRESTON WOODS LN APT 4
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3660
Mailing Address - Country:US
Mailing Address - Phone:910-605-2612
Mailing Address - Fax:
Practice Address - Street 1:3300 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-7624
Practice Address - Country:US
Practice Address - Phone:910-822-4965
Practice Address - Fax:910-822-5877
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist