Individual provider Active NPI

PO Yun Pan, PHARM.D.

  • Pharmacist
  • Brooklyn, NY
National Provider Identifier
1447898762
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
066408 Issued in NY
Practice address
589 Prospect Ave
Brooklyn, NY 11215-6020
Phone
(347) 955-3029
NPI assigned
Dec 17, 2019
Last updated
Sep 3, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 066408 NY Primary

Addresses

Primary practice location

589 Prospect Ave
Brooklyn, NY 11215-6020

Mailing address

589 Prospect Ave
Brooklyn, NY 11215-6020
Phone (347) 955-3029

Other practice location 1

114 Beverley Rd
Brooklyn, NY 11218-3914
Phone (718) 437-7802

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
066408NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co CurrentSince May 1, 2022 Accepting new patients
Walgreen Co PastSince Sep 5, 2021 Accepting new patients

Locations

589 Prospect Ave
Brooklyn, NY 11215
Phone (347) 955-3029

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1447898762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "589 PROSPECT AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112156020",
            "telephone_number": "347-955-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "589 PROSPECT AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112156020",
            "telephone_number": "347-955-3029"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "114 Beverley Rd",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112183914",
            "country_code": "US",
            "telephone_number": "718-437-7802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAN",
        "first_name": "PO",
        "middle_name": "YUN",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-17",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "066408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.