MEDICARE: MR. CHI LEUNG CHAN R.PH

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
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	29743	NY
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS21599	FL

General Provider Information

NPI Number	:	1205948569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHI LEUNG CHAN R.PH

Provider Business Mailing Address
First Line	:	1237 W ALEXANDER RD
Second Line	:	APT 102
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-9081
Country	:	US
Telephone Number	:	925-305-3333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1237 W ALEXANDER RD
Second Line	:	APT 102
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-9081
Country	:	US
Telephone Number	:	925-305-3333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/09/2009

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