# PROVISION PHARMACY, INC. -LTC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962366195
- **Authorized official:** DR. ALAN CHAN PHARM.D (CEO)
- **Authorized official phone:** (808) 854-8999

## Contact information

- **Practice address:** 4428 GLACIER AVE, SAN DIEGO, CA 92120-3304
- **Practice address phone:** (808) 854-8999
- **Mailing address:** 4428 GLACIER AVE, SAN DIEGO, CA 92120-3304
- **Mailing address phone:** (808) 854-8999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 12/11/2025
- **Last updated:** 12/11/2025