Provider Demographics
NPI:1548859853
Name:QUINONEZ, LISA BARON (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:BARON
Last Name:QUINONEZ
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 1:1523 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-5717
Mailing Address - Country:US
Mailing Address - Phone:754-200-5913
Mailing Address - Fax:754-223-3424
Practice Address - Street 1:1523 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-5717
Practice Address - Country:US
Practice Address - Phone:754-200-5913
Practice Address - Fax:754-223-3424
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist