Healthcare Provider Details

I. General information

NPI: 1215037478
Provider Name (Legal Business Name): VICKY CHAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 ARCH ST APT 4
PHILADELPHIA PA
19106-2227
US

IV. Provider business mailing address

126 ARCH ST APT 4
PHILADELPHIA PA
19106-2227
US

V. Phone/Fax

Practice location:
  • Phone: 267-519-0550
  • Fax:
Mailing address:
  • Phone: 267-519-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP439965
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: