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General NPI Number Information
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NPI Number | 1336505445
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Entity Type | Individual
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Provider Name | DANIEL CHEN
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Gender | Male
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 8495 CRATER LAKE HWY
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City | WHITE CITY
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State | OR
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Zip | 97503-3011
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Country | US
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Telephone | 978-390-7279
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Fax |
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Provider Business Mailing Address
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Address Line | 240 CHERRY BARK LN
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City | MEDFORD
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State | OR
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Zip | 97501-0292
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PCT0013345
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License Number State | CT
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