Individual
CHIN CHON NG CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
610 W TEFFT ST, NIPOMO, CA 93444-9187
(805) 929-2740
Mailing address
610 W TEFFT ST, NIPOMO, CA 93444-9187
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
80463
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80463
CALIFORNIA BOARD OF PHARMACY
CA
Enumeration date
05/09/2019
Last updated
05/09/2019
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