Healthcare Provider Details

I. General information

NPI: 1104736594
Provider Name (Legal Business Name): TIFFANNY QUACH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9245 RESEDA BLVD
NORTHRIDGE CA
91324-3137
US

IV. Provider business mailing address

6236 BECK AVE
NORTH HOLLYWOOD CA
91606-4003
US

V. Phone/Fax

Practice location:
  • Phone: 818-727-7234
  • Fax:
Mailing address:
  • Phone: 614-284-7621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: