Provider Demographics
NPI:1871804302
Name:MCQUIDDY, MICHAEL V (PHARMD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:V
Last Name:MCQUIDDY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
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Mailing Address - Street 1:900 GREENLEY RD
Mailing Address - Street 2:SUITE 912
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5287
Mailing Address - Country:US
Mailing Address - Phone:209-536-3701
Mailing Address - Fax:209-536-3511
Practice Address - Street 1:900 GREENLEY RD
Practice Address - Street 2:SUITE 912
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5287
Practice Address - Country:US
Practice Address - Phone:209-536-3701
Practice Address - Fax:209-536-3511
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA63590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist