MEDICARE: STACEY JANE PAN PHARMD

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	051301217	IL
2	183500000X	Pharmacist	62946	TX
3	183500000X	Pharmacist	PH237704	MA

General Provider Information

NPI Number	:	1568926426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY JANE PAN PHARMD

Provider Business Mailing Address
First Line	:	525 W MONROE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-3629
Country	:	US
Telephone Number	:	800-746-7287
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 W MONROE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-3629
Country	:	US
Telephone Number	:	847-746-7287
Fax Number	:

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

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	06/07/2026

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Directions to “ STACEY JANE PAN PHARMD” Practice Location

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