MEDICARE: BRIAN QUAN

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	PH-1857	HI

General Provider Information

NPI Number	:	1689958381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN QUAN

Provider Business Mailing Address
First Line	:	4561 SALT LAKE BLVD
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-3167
Country	:	US
Telephone Number	:	808-486-6449
Fax Number	:	808-486-8525

Provider Business Practice Location Address
First Line	:	4561 SALT LAKE BLVD
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-3167
Country	:	US
Telephone Number	:	808-486-6449
Fax Number	:	808-486-8525

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

Provider Enumeration Date	:	09/30/2011
Last Update Date	:	09/30/2011

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Directions to “ BRIAN QUAN ” Practice Location

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