MEDICARE: CHRISTINE CHAN

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	047039	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780869123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE CHAN

Provider Business Mailing Address
First Line	:	257 BAY 41ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6423 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5520
Country	:	US
Telephone Number	:	718-567-0890
Fax Number	:

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

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	01/03/2008

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Directions to “ CHRISTINE CHAN ” Practice Location

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