MEDICARE: MR. WAYNE CHAN 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
1	183500000X	Pharmacist	51696	CA

General Provider Information

NPI Number	:	1326348483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WAYNE CHAN PHARM D

Provider Business Mailing Address
First Line	:	2972 STALLION WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1782
Country	:	US
Telephone Number	:	408-710-5302
Fax Number	:	408-855-0989

Provider Business Practice Location Address
First Line	:	5760 COTTLE RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-3624
Country	:	US
Telephone Number	:	408-362-9623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2010
Last Update Date	:	09/05/2019

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Directions to “ MR. WAYNE CHAN PHARM D” Practice Location

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