Provider Demographics
NPI:1205111804
Name:CHAN, GINA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:PEI KAY
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3201 DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2501
Mailing Address - Country:US
Mailing Address - Phone:415-412-4195
Mailing Address - Fax:
Practice Address - Street 1:3201 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2501
Practice Address - Country:US
Practice Address - Phone:415-412-4195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist