Provider Demographics
NPI:1598088023
Name:CHAN, SIMON C (RPH)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:C
Last Name:CHAN
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 1:5925 KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5547
Mailing Address - Country:US
Mailing Address - Phone:718-939-2898
Mailing Address - Fax:718-661-0878
Practice Address - Street 1:5925 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5547
Practice Address - Country:US
Practice Address - Phone:718-939-2898
Practice Address - Fax:718-661-0878
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY045361OtherLICENSE