Provider Demographics
NPI:1306122098
Name:CHAN, BURTON (BSC PHM)
Entity type:Individual
Prefix:MR
First Name:BURTON
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:BSC PHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3663
Mailing Address - Country:US
Mailing Address - Phone:248-293-0627
Mailing Address - Fax:248-293-0644
Practice Address - Street 1:2985 CROOKS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3663
Practice Address - Country:US
Practice Address - Phone:248-293-0627
Practice Address - Fax:248-293-0644
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist