Provider Demographics
NPI:1881186526
Name:CHAN, CHARLES KEI-SING (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:KEI-SING
Last Name:CHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6303
Mailing Address - Country:US
Mailing Address - Phone:212-935-1819
Mailing Address - Fax:
Practice Address - Street 1:969 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6303
Practice Address - Country:US
Practice Address - Phone:212-935-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist