Provider Demographics
NPI:1104429224
Name:ONEIL, KEVIN QUINN JR
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:QUINN
Last Name:ONEIL
Suffix:JR
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 1:4390 JUNIPER TRL
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-7923
Mailing Address - Country:US
Mailing Address - Phone:775-741-7070
Mailing Address - Fax:
Practice Address - Street 1:2425 E 2ND ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1218
Practice Address - Country:US
Practice Address - Phone:775-359-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist