Provider Demographics
NPI:1023336682
Name:CHE-QUACH, TRACY DIEUTHAO (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:DIEUTHAO
Last Name:CHE-QUACH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 E SANTA ANA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3124
Mailing Address - Country:US
Mailing Address - Phone:714-998-4801
Mailing Address - Fax:714-998-8549
Practice Address - Street 1:5560 E SANTA ANA CANYON RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3124
Practice Address - Country:US
Practice Address - Phone:714-998-4801
Practice Address - Fax:714-998-8549
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42661OtherSTATE LICENSE