Provider Demographics
NPI:1144502147
Name:QUINONES, MANUEL E
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:E
Last Name:QUINONES
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 1:120 JEFFERSON AVE APT 12021
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-7077
Mailing Address - Country:US
Mailing Address - Phone:305-371-5868
Mailing Address - Fax:305-371-9611
Practice Address - Street 1:1 E FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-1003
Practice Address - Country:US
Practice Address - Phone:305-371-5868
Practice Address - Fax:305-371-9611
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist