MEDICARE: GRACIEL 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	19959	NV

General Provider Information

NPI Number	:	1932764180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACIEL CHAN PHARM.D.

Provider Business Mailing Address
First Line	:	6708 STONETRACE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5094
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7090 N 5TH ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1333
Country	:	US
Telephone Number	:	702-216-4502
Fax Number	:

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

Provider Enumeration Date	:	05/03/2019
Last Update Date	:	05/03/2019

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Directions to “ GRACIEL CHAN PHARM.D.” Practice Location

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