Individual
ETHAN NORIN CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
698 BANK ST, NEW LONDON, CT 06320-5040
(860) 772-9334
Mailing address
58 KENYON RD, WATERFORD, CT 06385-4214
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
PTT15131
MA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
PCI.0010039
CT
390200000X
Student in an Organized Health Care Education/Training Program
PI167939
MA
Other
Enumeration date
05/20/2022
Last updated
05/20/2022
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