Provider Demographics
NPI:1194273706
Name:QUACH, VAN TUONG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VAN
Middle Name:TUONG
Last Name:QUACH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5847 NE 75TH ST # A220
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8105
Mailing Address - Country:US
Mailing Address - Phone:206-653-5138
Mailing Address - Fax:
Practice Address - Street 1:23003 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-7269
Practice Address - Country:US
Practice Address - Phone:206-870-1832
Practice Address - Fax:206-870-1844
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60661107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60661107OtherWASHINGTON STATE DEPARTMENT OF HEALTH