Provider Demographics
NPI:1427882661
Name:CHAN, AUDRIE Z (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AUDRIE
Middle Name:Z
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 1:3316 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4408
Mailing Address - Country:US
Mailing Address - Phone:916-347-2187
Mailing Address - Fax:
Practice Address - Street 1:3316 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4408
Practice Address - Country:US
Practice Address - Phone:916-347-2187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist