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General NPI Number Information
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NPI Number | 1700507753
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Entity Type | Individual
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Provider Name | MASON JUNG CHAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/08/2022
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 150 MONUMENT RD
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1702
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Country | US
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Telephone | 267-581-5328
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Fax |
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Provider Business Mailing Address
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Address Line | 110 SIBLEY AVE APT 209
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City | ARDMORE
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State | PA
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Zip | 19003-2347
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Country | US
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Telephone | 917-815-6962
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 28RI04268200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | RP456786
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License Number State | PA
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