Provider Demographics
NPI:1366981490
Name:QUACH, VIVIAN VAN ANH BAO (PHARM D)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:VAN ANH BAO
Last Name: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 1:2502 POTRERO AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733
Mailing Address - Country:US
Mailing Address - Phone:626-213-7202
Mailing Address - Fax:
Practice Address - Street 1:2502 POTRERO AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1852
Practice Address - Country:US
Practice Address - Phone:626-213-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist