Provider Demographics
NPI:1316018534
Name:PAN, SIU M (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:SIU
Middle Name:M
Last Name:PAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:
Other - Last Name:PAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2314 241ST ST
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1007
Mailing Address - Country:US
Mailing Address - Phone:310-308-8635
Mailing Address - Fax:310-517-4176
Practice Address - Street 1:25825 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3518
Practice Address - Country:US
Practice Address - Phone:310-517-2386
Practice Address - Fax:310-517-4176
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist