Provider Demographics
NPI:1760645931
Name:ZHAO, NAN (RPH)
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:
Last Name:ZHAO
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 1:5624 185TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2219
Mailing Address - Country:US
Mailing Address - Phone:917-815-8898
Mailing Address - Fax:
Practice Address - Street 1:1082 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2802
Practice Address - Country:US
Practice Address - Phone:212-223-1130
Practice Address - Fax:212-223-2092
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist