Provider Demographics
NPI:1790052686
Name:CHAN, BECKY NGO (PHARM D)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:NGO
Last Name:CHAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32401 CAMINO CAPISTRANO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-4517
Mailing Address - Country:US
Mailing Address - Phone:949-661-3492
Mailing Address - Fax:949-661-6205
Practice Address - Street 1:32401 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-4517
Practice Address - Country:US
Practice Address - Phone:949-661-3492
Practice Address - Fax:949-661-6205
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist