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General NPI Number Information
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NPI Number | 1144995366
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Entity Type | Individual
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Provider Name | JAMES T QUACH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 8430 W BRYN MAWR AVE STE 690
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City | CHICAGO
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State | IL
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Zip | 60631
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Country | US
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Telephone | 630-202-8328
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 FRINGETREE LN
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City | WOODRIDGE
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State | IL
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Zip | 60517-4653
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Country | US
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Telephone | 630-202-8328
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051291228
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License Number State | IL
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