Provider Demographics
NPI:1053619569
Name:CHAN, WEI RONG (PHARMD)
Entity type:Individual
Prefix:
First Name:WEI RONG
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ELDRIDGE ST
Mailing Address - Street 2:8
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4427
Mailing Address - Country:US
Mailing Address - Phone:646-286-8519
Mailing Address - Fax:
Practice Address - Street 1:106 ELDRIDGE ST
Practice Address - Street 2:8
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4427
Practice Address - Country:US
Practice Address - Phone:646-286-8519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055438-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist