Provider Demographics
NPI:1720301245
Name:CHAN, LORETTA
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 BROADWAY
Mailing Address - Street 2:BROADWAY DOWNTOWN PHARMACY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3926
Mailing Address - Country:US
Mailing Address - Phone:212-925-4888
Mailing Address - Fax:212-925-4917
Practice Address - Street 1:373 BROADWAY
Practice Address - Street 2: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:212-925-4917
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist