Provider Demographics
NPI:1700910692
Name:CHAN, JOHN Y (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:Y
Last Name:CHAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25719 177TH PL SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5821
Mailing Address - Country:US
Mailing Address - Phone:253-850-0164
Mailing Address - Fax:
Practice Address - Street 1:17615 140TH AVE. SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-6828
Practice Address - Country:US
Practice Address - Phone:425-204-1585
Practice Address - Fax:425-204-0743
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00042489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist