Provider Demographics
NPI:1043505191
Name:TIMOTHY, ANNIE QUACH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:QUACH
Last Name:TIMOTHY
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 1:9400 192ND AVE E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8564
Mailing Address - Country:US
Mailing Address - Phone:253-862-6401
Mailing Address - Fax:253-853-6401
Practice Address - Street 1:9400 192ND AVE E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8564
Practice Address - Country:US
Practice Address - Phone:253-862-6401
Practice Address - Fax:253-853-6401
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60159172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist