Provider Demographics
NPI:1881915999
Name:CHAN, PATRICK (PHARMD)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 LONE HILL LN
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-7276
Mailing Address - Country:US
Mailing Address - Phone:858-759-8059
Mailing Address - Fax:
Practice Address - Street 1:3515 DEL MAR HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2122
Practice Address - Country:US
Practice Address - Phone:858-792-7040
Practice Address - Fax:858-792-8636
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist