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NPI Code Detail

MEDICARE: MS. LISA M. CHAN

MEDICARE: MS. LISA M. 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
1183500000XPharmacist042052NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407038516
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA M. CHAN
Provider Business Mailing Address
First Line : 1720 KINGS HWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-1208
Country : US
Telephone Number : 718-998-3377
Fax Number : 718-376-5686
Provider Business Practice Location Address
First Line : 1720 KINGS HWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-1208
Country : US
Telephone Number : 718-998-3377
Fax Number : 718-376-5686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2007
Last Update Date : 11/30/2007

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