Healthcare Provider Details

I. General information

NPI: 1245634351
Provider Name (Legal Business Name): REBECCA HUA-CHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8204 18TH AVE
BROOKLYN NY
11214-2901
US

IV. Provider business mailing address

8204 18TH AVE
BROOKLYN NY
11214-2901
US

V. Phone/Fax

Practice location:
  • Phone: 347-889-7050
  • Fax: 347-889-7053
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02533800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number049123-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: