Provider Demographics
NPI:1801117916
Name:CHAN, AMELIA (RPH)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:KAMTONG
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3308 SAN BENITO
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7595
Mailing Address - Country:US
Mailing Address - Phone:832-668-9288
Mailing Address - Fax:956-519-6768
Practice Address - Street 1:1520 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8832
Practice Address - Country:US
Practice Address - Phone:956-380-0540
Practice Address - Fax:956-380-5092
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-13
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist