Provider Demographics
NPI:1780897652
Name:QUENNEVILLE, DAVID CHARLES (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:QUENNEVILLE
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 1:129 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-1417
Mailing Address - Country:US
Mailing Address - Phone:978-372-1316
Mailing Address - Fax:
Practice Address - Street 1:129 MAIN ST
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:MA
Practice Address - Zip Code:01834-1417
Practice Address - Country:US
Practice Address - Phone:978-372-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist