Provider Demographics
NPI:1134442650
Name:CHAN, HENRY W (R PH)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:W
Last Name:CHAN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BLUE JAY CT
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-6748
Mailing Address - Country:US
Mailing Address - Phone:212-925-4888
Mailing Address - Fax:
Practice Address - Street 1:373 BROADWAY
Practice Address - Street 2:C/O BROADWAY DOWNTOWN PHARMACY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3926
Practice Address - Country:US
Practice Address - Phone:212-925-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist