Provider Demographics
NPI:1316254592
Name:QUAN, ASHLEY JAN-MEN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JAN-MEN
Last Name:QUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 2ND AVE
Mailing Address - Street 2:#400
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-3037
Mailing Address - Country:US
Mailing Address - Phone:205-915-0539
Mailing Address - Fax:
Practice Address - Street 1:22515 HWY 99
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8373
Practice Address - Country:US
Practice Address - Phone:425-670-2667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60109924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist