Provider Demographics
NPI:1366436180
Name:QUARANTILLO, MARTHA H (RPH)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:H
Last Name:QUARANTILLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 IRONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411-6359
Mailing Address - Country:US
Mailing Address - Phone:304-258-4417
Mailing Address - Fax:
Practice Address - Street 1:94 IRONWOOD LN
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-6359
Practice Address - Country:US
Practice Address - Phone:304-258-4417
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4026W183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist