Provider Demographics
NPI:1861663932
Name:CHAN, WINTER S (PHARMD)
Entity Type:Individual
Prefix:
First Name:WINTER
Middle Name:S
Last Name:CHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E 200 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2401
Mailing Address - Country:US
Mailing Address - Phone:801-585-0272
Mailing Address - Fax:801-581-3744
Practice Address - Street 1:911 E 200 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2401
Practice Address - Country:US
Practice Address - Phone:801-585-0272
Practice Address - Fax:801-581-3744
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5785953-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist