Provider Demographics
NPI:1578842902
Name:CHAN, HAI LUNG (PHARM D)
Entity Type:Individual
Prefix:
First Name:HAI
Middle Name:LUNG
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 1:149-29 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1323
Mailing Address - Country:US
Mailing Address - Phone:917-207-2556
Mailing Address - Fax:
Practice Address - Street 1:4331 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2250
Practice Address - Country:US
Practice Address - Phone:917-207-2556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055940-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist