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NPI Code Detail

MEDICARE: BETTY CHAN

MEDICARE: BETTY CHAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist11508OK

General Provider Information

NPI Number : 1194326652
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETTY CHAN
Provider Business Mailing Address
First Line : 2105 DANSMERE AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73170-3404
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1500 SW 59TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73119-7214
Country : US
Telephone Number : 405-684-9764
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2020
Last Update Date : 11/02/2020

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Directions to “ BETTY CHAN ” Practice Location

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