Healthcare Provider Details

I. General information

NPI: 1174927255
Provider Name (Legal Business Name): MELANIE CHAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12607 SE MILL PLAIN BLVD
VANCOUVER WA
98684-6055
US

IV. Provider business mailing address

11011 NE 89TH AVE
VANCOUVER WA
98662-1487
US

V. Phone/Fax

Practice location:
  • Phone: 800-813-2000
  • Fax:
Mailing address:
  • Phone: 503-997-5531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60482866
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0014687
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: