Provider Demographics
NPI:1164607826
Name:CHAN, ANNY (RPH)
Entity Type:Individual
Prefix:
First Name:ANNY
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:RT 517 VILLAGE SQUARE MALL
Mailing Address - City:ALLAMUCHY
Mailing Address - State:NJ
Mailing Address - Zip Code:07820
Mailing Address - Country:US
Mailing Address - Phone:908-852-8818
Mailing Address - Fax:908-852-8775
Practice Address - Street 1:RT 517 VILLAGE SQUQARE MALL
Practice Address - Street 2:
Practice Address - City:ALLAMUCHY
Practice Address - State:NJ
Practice Address - Zip Code:07820
Practice Address - Country:US
Practice Address - Phone:908-852-8818
Practice Address - Fax:908-852-8775
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R102371000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist