MEDICARE: VICKY W. PAN PHARM.D.

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	RPH 58434	CA

General Provider Information

NPI Number	:	1568757052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKY W. PAN PHARM.D.

Provider Business Mailing Address
First Line	:	362 25TH AVE APT 3
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-1965
Country	:	US
Telephone Number	:	415-238-1120
Fax Number	:

Provider Business Practice Location Address
First Line	:	3398 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-5009
Country	:	US
Telephone Number	:	415-824-6886
Fax Number	:

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

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	06/13/2011

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Directions to “ VICKY W. PAN PHARM.D.” Practice Location

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