Provider Demographics
NPI:1760896021
Name:CHAN, GARRY (PHARMD)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 ARVILLE ST
Mailing Address - Street 2:SUITE 156
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4936
Mailing Address - Country:US
Mailing Address - Phone:866-643-3546
Mailing Address - Fax:702-815-0801
Practice Address - Street 1:1002 S BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7234
Practice Address - Country:US
Practice Address - Phone:626-447-2138
Practice Address - Fax:626-447-6433
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 37144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist