Provider Demographics
NPI:1023843695
Name:CHAN, MAN KIT (PHARMD)
Entity type:Individual
Prefix:
First Name:MAN
Middle Name:KIT
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 1:409 N 9TH CT
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113-9145
Mailing Address - Country:US
Mailing Address - Phone:971-227-5549
Mailing Address - Fax:
Practice Address - Street 1:409 N 9TH CT
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:OR
Practice Address - Zip Code:97113-9145
Practice Address - Country:US
Practice Address - Phone:971-227-5549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0019927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist