Provider Demographics
NPI:1700261120
Name:CHAN, ANNA (PHARMD, CGP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:CHAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1330 ROCKEFELLER AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1684
Mailing Address - Country:US
Mailing Address - Phone:425-297-5220
Mailing Address - Fax:425-297-5221
Practice Address - Street 1:1330 ROCKEFELLER AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1684
Practice Address - Country:US
Practice Address - Phone:425-297-5220
Practice Address - Fax:425-297-5221
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000577661835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00057766OtherPHARMACIST LICENSE