Individual
JACK CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
807 LOCUST ST, PHILADELPHIA, PA 19107-5507
(215) 625-7902
(215) 625-7906
Mailing address
807 LOCUST ST, PHILADELPHIA, PA 19107-5507
(215) 625-7902
(215) 625-7906
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP451120
PA
Other
Enumeration date
10/03/2016
Last updated
10/03/2016
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