Provider Demographics
NPI:1861094575
Name:QUACH, PHAT KIM (PHARM D)
Entity type:Individual
Prefix:
First Name:PHAT
Middle Name:KIM
Last Name:QUACH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2332
Mailing Address - Country:US
Mailing Address - Phone:504-309-4388
Mailing Address - Fax:504-309-4389
Practice Address - Street 1:1400 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2332
Practice Address - Country:US
Practice Address - Phone:504-309-4388
Practice Address - Fax:504-309-4389
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA17260OtherPHARMACIST LICENSE'S NUMBER