Provider Demographics
NPI:1326348483
Name:CHAN, WAYNE (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2972 STALLION WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1782
Mailing Address - Country:US
Mailing Address - Phone:408-710-5302
Mailing Address - Fax:408-855-0989
Practice Address - Street 1:5760 COTTLE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3624
Practice Address - Country:US
Practice Address - Phone:408-362-9623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist