Provider Demographics
NPI:1720253909
Name:QUARANTA, MICHAEL V (R PH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:QUARANTA
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840688
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0688
Mailing Address - Country:US
Mailing Address - Phone:800-225-5967
Mailing Address - Fax:909-799-4364
Practice Address - Street 1:19102 N CREEK PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-8005
Practice Address - Country:US
Practice Address - Phone:800-225-5967
Practice Address - Fax:909-799-4364
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist