Provider Demographics
NPI:1811219611
Name:CHIU-CHAN, CONNIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:CHIU-CHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1613
Mailing Address - Country:US
Mailing Address - Phone:516-409-9442
Mailing Address - Fax:
Practice Address - Street 1:703 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1613
Practice Address - Country:US
Practice Address - Phone:516-409-9442
Practice Address - Fax:516-409-4126
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI046985-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist