Provider Demographics
NPI:1790161040
Name:CHAN, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1488 KAPIOLANI BLVD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3716
Mailing Address - Country:US
Mailing Address - Phone:808-949-8500
Mailing Address - Fax:808-949-8359
Practice Address - Street 1:1488 KAPIOLANI BLVD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3716
Practice Address - Country:US
Practice Address - Phone:808-949-8500
Practice Address - Fax:808-949-8359
Is Sole Proprietor?:No
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH3581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist