Provider Demographics
NPI:1538116512
Name:GAN, TECK H (RPH)
Entity Type:Individual
Prefix:
First Name:TECK
Middle Name:H
Last Name:GAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PEARCE PL
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3239
Mailing Address - Country:US
Mailing Address - Phone:212-686-7500
Mailing Address - Fax:
Practice Address - Street 1:3214 BERGENLINE AVE
Practice Address - Street 2:UNION CITY PHARMACY
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3935
Practice Address - Country:US
Practice Address - Phone:201-250-8290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist