Healthcare Provider Details

I. General information

NPI: 1235237587
Provider Name (Legal Business Name): MABEL LANE CHIN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

1321 LEXINGTON DR
YARDLEY PA
19067-4437
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5800
  • Fax: 215-823-4407
Mailing address:
  • Phone: 215-493-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number07103
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: