Basic Information
| Provider Information | |||||||||
| NPI: | 1538116512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAN | ||||||||
| FirstName: | TECK | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 PEARCE PL | ||||||||
| Address2: | |||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110213239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126867500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3214 BERGENLINE AVE | ||||||||
| Address2: | UNION CITY PHARMACY | ||||||||
| City: | UNION CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070873935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012508290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 02/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 043943 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.