Provider Demographics
NPI:1073945325
Name:PAN, SHUHUAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHUHUAN
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:PAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:701 N CABLE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 N CABLE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1737
Practice Address - Country:US
Practice Address - Phone:419-222-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH-03120468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist