Provider Demographics
NPI:1053891887
Name:QUINATE PHARMACY LLC
Entity type:Organization
Organization Name:QUINATE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-509-3330
Mailing Address - Street 1:1557 POOLER PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4389
Mailing Address - Country:US
Mailing Address - Phone:912-653-1000
Mailing Address - Fax:912-295-4667
Practice Address - Street 1:546 W BACON ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:GA
Practice Address - Zip Code:31321-4648
Practice Address - Country:US
Practice Address - Phone:912-653-1000
Practice Address - Fax:912-295-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE010656OtherGEORGIA BOARD OF PHARMACY