Healthcare Provider Details

I. General information

NPI: 1083601215
Provider Name (Legal Business Name): MAGGIE W K CHAN PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 W MAIN ST
LEOLA PA
17540-2107
US

IV. Provider business mailing address

1106 COUNTRY PLACE DR
LANCASTER PA
17601-7110
US

V. Phone/Fax

Practice location:
  • Phone: 717-656-3784
  • Fax: 717-656-8388
Mailing address:
  • Phone: 717-898-6375
  • Fax: 717-898-6375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP029376L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: