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NPI Code Detail

MEDICARE: MRS. TRACY DIEUTHAO CHE-QUACH PHARM D.

MEDICARE: MRS. TRACY DIEUTHAO CHE-QUACH PHARM D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist42661CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
142661OTHERCASTATE LICENSE

General Provider Information

NPI Number : 1023336682
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACY DIEUTHAO CHE-QUACH PHARM D.
Provider Business Mailing Address
First Line : 5560 E SANTA ANA CANYON RD
Second Line :
City : ANAHEIM
State : CA
Zip : 92807-3124
Country : US
Telephone Number : 714-998-4801
Fax Number : 714-998-8549
Provider Business Practice Location Address
First Line : 5560 E SANTA ANA CANYON RD
Second Line :
City : ANAHEIM
State : CA
Zip : 92807-3124
Country : US
Telephone Number : 714-998-4801
Fax Number : 714-998-8549
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2010
Last Update Date : 05/06/2010

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