Provider Demographics
NPI:1093374472
Name:VANG, CHAO CHANG (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHAO
Middle Name:CHANG
Last Name:VANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3774 HALYARD CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-4963
Mailing Address - Country:US
Mailing Address - Phone:209-981-2235
Mailing Address - Fax:
Practice Address - Street 1:2605 W MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6522
Practice Address - Country:US
Practice Address - Phone:209-952-3494
Practice Address - Fax:209-955-1847
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty