Provider Demographics
NPI:1407132400
Name:CHAN, ARLENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:
Last Name:CHAN
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 1:701 NORTH CABLE ROAD
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:419-222-9462
Mailing Address - Fax:
Practice Address - Street 1:701 NORTH CABLE ROAD
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:419-222-8345
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-25604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist