Provider Demographics
NPI:1245553064
Name:CHIN-WAN, SANDRA LISA (BSC PHARM)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LISA
Last Name:CHIN-WAN
Suffix:
Gender:F
Credentials:BSC PHARM
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:CHIN-WAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1559 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4105
Mailing Address - Country:US
Mailing Address - Phone:718-627-0053
Mailing Address - Fax:
Practice Address - Street 1:1559 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4105
Practice Address - Country:US
Practice Address - Phone:718-627-0053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist