Healthcare Provider Details

I. General information

NPI: 1194676080
Provider Name (Legal Business Name): KANCHAN LIQUOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 FILLMORE ST
SAN FRANCISCO CA
94115-4711
US

IV. Provider business mailing address

1101 FILLMORE ST
SAN FRANCISCO CA
94115-4711
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-0771
  • Fax: 415-567-3342
Mailing address:
  • Phone: 415-567-0771
  • Fax: 415-567-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HANK CHEN
Title or Position: PIC
Credential: RPH
Phone: 415-567-0771