MEDICARE: JONATHAN CHAN PHARMD

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	183500000X	Pharmacist	21072	NV

General Provider Information

NPI Number	:	1245908235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN CHAN PHARMD

Provider Business Mailing Address
First Line	:	1808 MAGDELENA RIDGE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-3013
Country	:	US
Telephone Number	:	909-728-2889
Fax Number	:

Provider Business Practice Location Address
First Line	:	3041 W HORIZON RIDGE PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4444
Country	:	US
Telephone Number	:	702-778-8880
Fax Number	:	702-910-3799

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

Provider Enumeration Date	:	09/02/2021
Last Update Date	:	09/02/2021

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