Provider Demographics
NPI:1881879351
Name:CHAN, NANCY C (R PH)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:CHAN
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 BEAUMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1400
Mailing Address - Country:US
Mailing Address - Phone:650-335-5185
Mailing Address - Fax:650-742-2632
Practice Address - Street 1:455 BEAUMONT BLVD
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1400
Practice Address - Country:US
Practice Address - Phone:650-335-5185
Practice Address - Fax:650-742-2632
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398591835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric