MEDICARE: TECK H GAN RPH

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	043943	NY

General Provider Information

NPI Number	:	1538116512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TECK H GAN RPH

Provider Business Mailing Address
First Line	:	20 PEARCE PL
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-3239
Country	:	US
Telephone Number	:	212-686-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3214 BERGENLINE AVE
Second Line	:	UNION CITY PHARMACY
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3935
Country	:	US
Telephone Number	:	201-250-8290
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	02/13/2012

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