Healthcare Provider Details

I. General information

NPI: 1760046148
Provider Name (Legal Business Name): EMILY HAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 BANCROFT RD
WALNUT CREEK CA
94598-1531
US

IV. Provider business mailing address

738 BANCROFT RD
WALNUT CREEK CA
94598-1593
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-8525
  • Fax:
Mailing address:
  • Phone: 925-938-8525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: