Provider Demographics
NPI:1194214668
Name:QUERIMIT, DORIS MARQUEZ
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:MARQUEZ
Last Name:QUERIMIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HARMON LOOP ROAD, STE. 100
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929
Mailing Address - Country:US
Mailing Address - Phone:671-649-6831
Mailing Address - Fax:671-649-6832
Practice Address - Street 1:600 HARMON LOOP ROAD, STE. 100
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-649-6831
Practice Address - Fax:671-649-6832
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPH026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist