MEDICARE: COURTNEY 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	RP456177	PA

General Provider Information

NPI Number	:	1932853272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY CHAN

Provider Business Mailing Address
First Line	:	1415 MOORE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 E CITY AVE
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2448
Country	:	US
Telephone Number	:	610-667-7021
Fax Number	:

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

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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Directions to “ COURTNEY CHAN ” Practice Location

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