Healthcare Provider Details

I. General information

NPI: 1700910692
Provider Name (Legal Business Name): JOHN Y CHAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17615 140TH AVE. SE
RENTON WA
98058-6828
US

IV. Provider business mailing address

25719 177TH PL SE
COVINGTON WA
98042-5821
US

V. Phone/Fax

Practice location:
  • Phone: 425-204-1585
  • Fax: 425-204-0743
Mailing address:
  • Phone: 253-850-0164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00042489
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: