MEDICARE: VICTORIA YEN CHAN PHARMD

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	RP445757	PA

General Provider Information

NPI Number	:	1861804171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA YEN CHAN PHARMD

Provider Business Mailing Address
First Line	:	730 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-2312
Country	:	US
Telephone Number	:	215-627-6433
Fax Number	:	215-627-6406

Provider Business Practice Location Address
First Line	:	730 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-2312
Country	:	US
Telephone Number	:	215-627-6433
Fax Number	:	215-627-6406

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

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	05/21/2014

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