Provider Demographics
NPI:1023610334
Name:CHAN, SIN
Entity type:Individual
Prefix:
First Name:SIN
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 1:6 CIVIC CENTER DR APT 3
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 MAIN ST. EXTENSION
Practice Address - Street 2:SUITE 10
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872
Practice Address - Country:US
Practice Address - Phone:844-785-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04133200183500000X
NY067464183500000X
WI19858-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist