Healthcare Provider Details

I. General information

NPI: 1255454492
Provider Name (Legal Business Name): EDMOND CHIN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W COLLEGE AVE APT 17
ADA OH
45810-1399
US

IV. Provider business mailing address

14525 SW MILLIKAN WAY #12322
BEAVERTON OR
97005
US

V. Phone/Fax

Practice location:
  • Phone: 614-314-1889
  • Fax:
Mailing address:
  • Phone: 614-314-1889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number330101051152863
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH.03230464-2
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: