Provider Demographics
NPI:1750754651
Name:NORMAN, QUENTIN
Entity type:Individual
Prefix:
First Name:QUENTIN
Middle Name:
Last Name:NORMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-6957
Mailing Address - Country:US
Mailing Address - Phone:513-352-3094
Mailing Address - Fax:513-352-2920
Practice Address - Street 1:1525 ELM ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-6957
Practice Address - Country:US
Practice Address - Phone:513-352-3094
Practice Address - Fax:513-352-2920
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist