Provider Demographics
NPI:1821403452
Name:CHAN, WING
Entity Type:Individual
Prefix:
First Name:WING
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1487
Mailing Address - Street 2:
Mailing Address - City:SOLOMONS
Mailing Address - State:MD
Mailing Address - Zip Code:20688-1487
Mailing Address - Country:US
Mailing Address - Phone:410-326-6731
Mailing Address - Fax:410-326-0024
Practice Address - Street 1:13390 HG TRUEMAN RD
Practice Address - Street 2:
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-1487
Practice Address - Country:US
Practice Address - Phone:410-326-6731
Practice Address - Fax:410-326-0024
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist