Healthcare Provider Details

I. General information

NPI: 1932012184
Provider Name (Legal Business Name): CHRISTOPHER CHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2329
US

IV. Provider business mailing address

2500 N RAINBOW BLVD APT 1066
LAS VEGAS NV
89108-4542
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2656
  • Fax:
Mailing address:
  • Phone: 323-485-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25343
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: