Healthcare Provider Details

I. General information

NPI: 1225764673
Provider Name (Legal Business Name): ANTHONY CHE QUACH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

9300 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-2460
  • Fax:
Mailing address:
  • Phone: 619-543-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number86328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: