Healthcare Provider Details

I. General information

NPI: 1346931102
Provider Name (Legal Business Name): NICHOLAS CHIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SNYDER AVE
PHILADELPHIA PA
19148-2700
US

IV. Provider business mailing address

1642 S 12TH ST
PHILADELPHIA PA
19148-1002
US

V. Phone/Fax

Practice location:
  • Phone: 215-465-3270
  • Fax:
Mailing address:
  • Phone: 609-350-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP457543
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: