Provider Demographics
NPI:1689955965
Name:KU, KAN CHAN (RPH)
Entity Type:Individual
Prefix:
First Name:KAN
Middle Name:CHAN
Last Name:KU
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 1:822 CRYSTAL PALACE CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2256
Mailing Address - Country:US
Mailing Address - Phone:410-654-1695
Mailing Address - Fax:
Practice Address - Street 1:5657 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1412
Practice Address - Country:US
Practice Address - Phone:410-788-1207
Practice Address - Fax:410-788-1964
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist