Provider Demographics
NPI:1144548082
Name:CHAN, PAUL JR
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:CHAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 HOPYARD RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5241
Mailing Address - Country:US
Mailing Address - Phone:925-846-8345
Mailing Address - Fax:
Practice Address - Street 1:2819 HOPYARD RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5241
Practice Address - Country:US
Practice Address - Phone:925-846-8345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-16
Last Update Date:2010-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist