Provider Demographics
NPI:1598033615
Name:QUACH, TY VAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:TY
Middle Name:VAN
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 1:1501 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4001
Mailing Address - Country:US
Mailing Address - Phone:323-727-9117
Mailing Address - Fax:323-727-9545
Practice Address - Street 1:1501 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4001
Practice Address - Country:US
Practice Address - Phone:323-727-9117
Practice Address - Fax:323-727-9545
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist