Provider Demographics
NPI:1699058545
Name:QUECAN-GARCIA, MARTHA (RPH)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:QUECAN-GARCIA
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 1:22 HARWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:201-925-0755
Mailing Address - Fax:
Practice Address - Street 1:639 EAST 18 TH ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501
Practice Address - Country:US
Practice Address - Phone:973-925-8885
Practice Address - Fax:973-925-8955
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03169900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist