Provider Demographics
NPI:1487976650
Name:CHAN, SIMON (PHARMD)
Entity type:Individual
Prefix:
First Name:SIMON
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 1:2495 BROADWAY
Mailing Address - Street 2:CVS #6066
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7427
Mailing Address - Country:US
Mailing Address - Phone:212-787-2194
Mailing Address - Fax:
Practice Address - Street 1:2495 BROADWAY
Practice Address - Street 2:CVS #6066
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7427
Practice Address - Country:US
Practice Address - Phone:212-787-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist