MEDICARE: JIAN QUAN CHEN 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	064458	NY

General Provider Information

NPI Number	:	1386126894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIAN QUAN CHEN PHARMD

Provider Business Mailing Address
First Line	:	55 W 25TH ST APT 21K
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-2144
Country	:	US
Telephone Number	:	917-353-5102
Fax Number	:

Provider Business Practice Location Address
First Line	:	1091 OGDEN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-4601
Country	:	US
Telephone Number	:	718-293-5271
Fax Number	:

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

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	12/12/2019

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