Provider Demographics
NPI:1518782028
Name:QUIJANO, JUSTIN (RPH)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:QUIJANO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5057 TIMEPIECE CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2045
Mailing Address - Country:US
Mailing Address - Phone:209-565-7511
Mailing Address - Fax:
Practice Address - Street 1:7929 LOWER SACRAMENTO RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3723
Practice Address - Country:US
Practice Address - Phone:209-474-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist