Provider Demographics
NPI:1063122513
Name:SIN, VICKY KWAN (RPH)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:KWAN
Last Name:SIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MAIDEN LN
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3409
Mailing Address - Country:US
Mailing Address - Phone:508-269-4560
Mailing Address - Fax:
Practice Address - Street 1:324 WESTON RD
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-4509
Practice Address - Country:US
Practice Address - Phone:781-235-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-24
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist