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General NPI Number Information
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NPI Number | 1831434364
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Entity Type | Individual
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Provider Name | MAN SHAN CHAN PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 6413 18TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11204-3730
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Country | US
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Telephone | 718-256-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 57 RUTH PL
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City | STATEN ISLAND
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State | NY
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Zip | 10305-2430
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Country | US
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Telephone | 201-687-9849
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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 | 057451
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License Number State | NY
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