Provider Demographics
NPI:1942587654
Name:CHAN, MICHAEL C (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:CHAN
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 YORK ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-2320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4719
Practice Address - Country:US
Practice Address - Phone:631-843-0500
Practice Address - Fax:631-963-9002
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist