Provision Pharmacy, Inc. -LTC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

PROVISION PHARMACY, INC. -LTC

Practice address

4428 Glacier Ave
San Diego, CA 92120-3304

Phone

(808) 854-8999

NPI assigned

Dec 11, 2025

Last updated

Dec 11, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Alan Chan, PHARM.DNPI 1609297472

Title

Ceo

Phone

(808) 854-8999

Specialties & licenses 1

Addresses

Tax ID family

Provision Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Provision Pharmacy, Inc.

  • Community/Retail Pharmacy
  • San Diego, CA
  • NPI 1417811647
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alan P Chan, PHARM.D

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • San Francisco, CA
  • NPI 1609297472
  NPD Authorized official

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

{
    "created_epoch": "1765411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765411200000",
    "number": "1962366195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4428 GLACIER AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921203304",
            "telephone_number": "808-854-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4428 GLACIER AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921203304",
            "telephone_number": "808-854-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION PHARMACY, INC. -LTC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-11",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "808-854-8999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marisa Provenzano, LCSW
• Brooke Proverb
• Provident Home Health Care, Inc.
• Caitlin Reese Suarez Provido
• Provision Pharmacy, Inc.
• Melissa Provost
• Kayleigh Prowse, NP
• Proxima Medical Group
• Brigite Prud'Homme
• Elizabeth Pruett

• Long Term Care Pharmacy in San Diego, CA
• Providers in San Diego, CA by specialty
• Long Term Care Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2025; 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.