Provider Demographics
NPI:1679137913
Name:QUANG, NICOLE V (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:V
Last Name:QUANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18847 PALM ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6450
Mailing Address - Country:US
Mailing Address - Phone:714-717-1068
Mailing Address - Fax:
Practice Address - Street 1:1055 W 7TH ST FL 14
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2577
Practice Address - Country:US
Practice Address - Phone:213-694-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist