MEDICARE: GARRY CHAN 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 37144	CA

General Provider Information

NPI Number	:	1760896021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRY CHAN PHARM.D.

Provider Business Mailing Address
First Line	:	5275 ARVILLE ST
Second Line	:	SUITE 156
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4936
Country	:	US
Telephone Number	:	866-643-3546
Fax Number	:	702-815-0801

Provider Business Practice Location Address
First Line	:	1002 S BALDWIN AVE
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-7234
Country	:	US
Telephone Number	:	626-447-2138
Fax Number	:	626-447-6433

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

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	11/30/2014

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