Provider Demographics
NPI:1598906661
Name:CHAN, SHERYL (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 W 37TH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7497
Mailing Address - Country:US
Mailing Address - Phone:800-746-9089
Mailing Address - Fax:212-398-4812
Practice Address - Street 1:6310 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3998
Practice Address - Country:US
Practice Address - Phone:800-556-4246
Practice Address - Fax:817-263-0844
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist