Provider Demographics
NPI:1073801585
Name:WAN, KAITY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KAITY
Middle Name:
Last Name:WAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2115
Mailing Address - Country:US
Mailing Address - Phone:646-336-8491
Mailing Address - Fax:
Practice Address - Street 1:585 HUDSON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-2115
Practice Address - Country:US
Practice Address - Phone:646-336-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist