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General NPI Number Information
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NPI Number | 1417558248
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Entity Type | Individual
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Provider Name | JOHN CHAN RPH
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Gender | Male
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 678 N WELLS ST
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City | CHICAGO
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State | IL
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Zip | 60654-3717
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Country | US
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Telephone | 312-255-0425
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Fax |
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Provider Business Mailing Address
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Address Line | 880 W 27TH ST APT C
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City | CHICAGO
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State | IL
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Zip | 60608-5942
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Country | US
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Telephone | 312-823-5020
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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 | 051303465
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License Number State | IL
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