Provider Demographics
NPI:1861566309
Name:CHAN, PATEL & LUO LLP
Entity type:Organization
Organization Name:CHAN, PATEL & LUO LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:206-621-8883
Mailing Address - Street 1:611 MAYNARD AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2920
Mailing Address - Country:US
Mailing Address - Phone:206-621-8883
Mailing Address - Fax:206-621-9328
Practice Address - Street 1:611 MAYNARD AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2920
Practice Address - Country:US
Practice Address - Phone:206-621-8883
Practice Address - Fax:206-621-9328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00056137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6021398Medicaid
WA1285060001Medicare ID - Type Unspecified