Provider Demographics
NPI:1720864671
Name:SHORT, QUINN HATTAWAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:QUINN
Middle Name:HATTAWAY
Last Name:SHORT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:QUINN
Other - Middle Name:CATHERINE
Other - Last Name:HATTAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 19TH ST S # JT1728
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S # JT1728
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1900
Practice Address - Country:US
Practice Address - Phone:256-527-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist