Provider Demographics
NPI:1861674129
Name:PAN, SHARLENE S (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHARLENE
Middle Name:S
Last Name:PAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SHARLENE
Other - Middle Name:SAULING
Other - Last Name:CHAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5628 230TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2022
Mailing Address - Country:US
Mailing Address - Phone:718-631-8763
Mailing Address - Fax:
Practice Address - Street 1:14429 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4230
Practice Address - Country:US
Practice Address - Phone:718-886-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01562418Medicaid