Vivian W Fan

Primary specialty

PharmacistTaxonomy code 183500000X

License

039255 Issued in NY

Practice address

5508 Metropolitan Ave
Ridgewood, NY 11385-1221

Phone

(718) 418-3841

NPI assigned

Dec 26, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Vivian Wei-Yi Fan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Rite Aid of New York Inc

  dba Rite Aid Pharmacy 04570

  • Community/Retail Pharmacy
  • Ridgewood, NY
  • NPI 1588774475
  NPD (past)

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198627200000",
    "number": "1720262835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21958 64TH AVE",
            "address_2": "APT#C",
            "city": "OAKLAND GARDENS",
            "state": "NY",
            "postal_code": "113642246",
            "telephone_number": "718-631-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5508 METROPOLITAN AVE",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113851221",
            "telephone_number": "718-418-3841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "VIVIAN",
        "middle_name": "W",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-26",
        "last_updated": "2007-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "039255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01665838",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIVIAN",
            "last_name": "FAN",
            "middle_name": "WEI-YI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Eye Care Optical of Ny Inc (Eye Care Optical)
• Eyebiznet, Inc. (Ridgewood Opticians)
• Eyecare Advantage, Inc. (Eyecare Vision Services)
• Matthew Fama
• Family Choice Dental Care P.C.
• Gerges Fanous
• Maria Michelle Fareri, M.S., CCC-SLP
• Madison Rae Farr, PMHNP
• Farzin Farokhzadeh DDS PC (patient friendly dental)
• Joanne San Juan Fedelicio, MSN RN

• Pharmacist in Ridgewood, NY
• Providers in Ridgewood, NY by specialty
• Pharmacist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2007; 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.