Provider Demographics
NPI:1831400365
Name:QUINN, TIM
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:QUINN
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 1:552 REVERE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8708
Mailing Address - Country:US
Mailing Address - Phone:610-436-6767
Mailing Address - Fax:610-436-0505
Practice Address - Street 1:929 S HIGH ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-5466
Practice Address - Country:US
Practice Address - Phone:610-436-6767
Practice Address - Fax:610-436-0505
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039161L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist