Healthcare Provider Details

I. General information

NPI: 1568926426
Provider Name (Legal Business Name): STACEY JANE PAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W MONROE ST
CHICAGO IL
60661-3629
US

IV. Provider business mailing address

525 W MONROE ST
CHICAGO IL
60661-3629
US

V. Phone/Fax

Practice location:
  • Phone: 800-746-7287
  • Fax:
Mailing address:
  • Phone: 800-746-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051301217
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62946
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH237704
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: