Provider Demographics
NPI:1437558376
Name:QUACH, KHAI T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KHAI
Middle Name:T
Last Name:QUACH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 MONTECITO DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2927
Mailing Address - Country:US
Mailing Address - Phone:626-236-8418
Mailing Address - Fax:
Practice Address - Street 1:3250 BIG DALTON AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5107
Practice Address - Country:US
Practice Address - Phone:626-814-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist