Provider Demographics
NPI:1336247030
Name:CHAN, JULIANA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 14TH ST
Mailing Address - Street 2:UNIT 2909
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2889
Mailing Address - Country:US
Mailing Address - Phone:312-413-8282
Mailing Address - Fax:773-913-1972
Practice Address - Street 1:833 S WOOD ST RM 164
Practice Address - Street 2:MC 886
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7229
Practice Address - Country:US
Practice Address - Phone:312-413-8282
Practice Address - Fax:773-913-1972
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI#5302031414183500000X
MA#23607183500000X
IL#051-2871461835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist